In RMNCH+A Startegy, what is plus -

Ans. is 'a' i.e., Adolescent health o The RMNCH+A strategy is based on provision of comprehensive care through the five pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal care, entitlement, and accountability. The "plus" within the strategy focusses on :# Including adolescence for the first time as a distinct life stage.# Linking maternal and child health to reproductive health, family planning, adolescent health. HIV, gender, preconception and prenatal diagnostic techniques.# Linking home and community-based services to facility-based care.# Ensuring linkages, referrals, and counter-referrals between and among health facilities at primary (primary health centre), secondary (community health centre), and tertiary levels (district hospital).o Reduce anemia at 6% annual rate in adolescent is coverage target ( not goal) for RMNCH + A -Reproductive, maternal, newborn, child and adolescent health (RMNCH+A) stratery, 2013o In June 2012, the Government of India, Ethiopia, USA and the UNICEF convened the "Global Child Survival Call to Action : A Promise to Keep" summit in Washington, DC to energize the global fight to end preventable child deaths through targeted interventions in effective, life-saving interventions for children. More than 80 countries gathered at the Call to Action to pledge to reduce child mortality to < 20 child deaths per 1000 live births in every country by 2035. Eight months after the event, in February 2013, the Government of India held its own historic Summit on the Call to Action for Child Survival, where it launched "A Strategic Approach to Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) in India." Since that time, RMNCH+A has become the heart of the Government of India's flagship public health programme, the National Health Mission.o The RMNCH+A strategy is based on provision of comprehensive care through the five pillars, or thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal care, entitlement, and accountability. The "plus" within the strategy focusses on :# Including adolescence for the first time as a distinct life stage.# Linking maternal and child health to reproductive health, family planning, adolescent health. HIV, gender, preconception and prenatal diagnostic techniques.# Linking home and community-based services to facility-based care.# Ensuring linkages, referrals, and counter-referrals between and among health facilities at primary (primary health centre), secondary (community health centre), and tertiary levels (district hospital).o In developing the RMNCH+A strategy, the aim is to reach the maximum number of people in the remotest comers of the country. Guidelines and tools were developed and policies were adjusted.1) High-Priority Districts : Uniform and clearly defined criteria were used to identify 184 high-priority districts across all 29 states.2) Management tools andjob aids : The RMNCH+A 5><5 matrix identifies five high-impact interventions across each of the five thematic areas, five cross-cutting and health systems strengthening interventions, and, the minimum essential commodities across each of the thematic areas. The 5x5 matrix as shown in table, is an important tool for explaining the strategy in simple terms, organizing technical support, and monitoring progress with the states and high-priority districts.Reproductive healthMaternal healthNewborn healthChild healthAdolescent health# Focus on spacing methods, particularly PPIUCD at high case load facilities.# Focus on interval IUCD at all facilities including subcentres on fixed days.# Home delivery of Contraceptives (HDC) and Ensuring Spacing at Birth (ESB) through ASHAs.# Ensuring access to Pregnancy Testing Kits (PTK "Nischay Kits") and strengthening comprehensive abortion care services.# Maintaining quality sterilization services.# Use MCTS to ensure early registration of pregnancy and full ANC.# Detect high risk pregnancies and line list including severely anaemic mothers and ensure appropriate management.# Equip delivery points with highly trained HR and ensure equitable access to EmOC services through FRUs, Add MCH wings as per need.# Review maternal, infant and child deaths for corrective actions.o Identify villages with high numbers of home deliveries and distribute Misoprostol to selected women in 8th month of pregnancy for consumption during 3rd stage of labour; Incentivize ANMs for home deliveries.# Early initiation and exclusive breastfeeding.# Home based newborn care through ASHA.# Essential Newborn Care and resuscitation services at all delivery points.# Special Newborn Care Units with highly trained human resource and other infrastructure.# Community level use of Gentamycin by ANM.# Complementary feeding, IFA supplementation and focus on nutrition.# Diarrhoea management at community level using ORS and Zinc.# Management of pneumonia.# Full immunization coverage.# Rashtriya Bal Swasthya Karyakram (RBSK); screening of children for 4D's (birth defects, development delays, deficiencies and disease) and its management.# Address teenage pregnancy and increase contraceptive prevalence in adolescents.# Introduce community based services through peer educators.# Strengthen ARSH clinics.# Roll out National Iron Plus Initiative including weekly IFAsupplementation.# Promote menstrual hygiene. Health Systems StrengtheningCross Cutting Interventions# Cases load based deployment of HR at all levels.# Ambulances, drugs, diagnostics, reproductive health commodities.# Health education, demand promotion & behaviour change communication.# Supportive supervision and use of data for monitoring and review, including scorecards based on HMIS.# Public grievances redressal mechanism, client satisfaction and patient safety through all round quality assurance.# Bring down out of pocket expenses by ensuring ISSK, RBSK and other free entitlements.# ANMs & Nurses to provide specialized and quality care to pregnant women and children.# Address social determinants of health through convergence.# Focus on un-served and underserved villages, urban slums and blocks.# Introduce difficult area and performance based incentives.5x5 matrix for high impact RMNCH+A interventionsTo be implemented with High Coverage and High QualityGoals and Targetso The 12th Five Year Plan has defined the national health outcomes and the three goals that are relevant to RMNCH+A strategic approach are as follows :# Reduction of Infant Mortality Rate (IMR) to 25 per 1,000 live births by 2017.# Reduction in Maternal Mortality Ratio (MMR) to 100 per 100,000 live births by 2017.# Reduction in Total Fertility Rate (TFR) to 2[?]1 by 2017.o For achieving these goals, variable increase in the coverage level for key interventions are required. These are defined in the table.Coverage targets for key RMNCH+A interventions for 2017# Increase facilities equipped for perinatal care (designated as 'delivery points') by 100%.# Increase proportion of all births in government and accredited private institutions at annual rate of 5[?]6% from the baseline of 60% (SRS 2010).# Increase proportion of pregnant women receiving antenatal care at annual rate of 6% from the baseline of 53% (CES 2009).# Increase proportion of mothers and newborns receiving postnatal care at annual rate of 7[?]5% from the baseline of 45% (CES 2009).# Increase proportion of deliveries conducted by skilled birth attendants at annual rate of 2% from the baseline of 76% (CES 2009).# Increase exclusive breast-feeding rates at annual rate of 9-6% from the baseline of 35% (CES 2009).# Reduce prevalence of under-five children who are underweight at annual rate of 5[?]5% from the baseline of 45% (NFHS-3).# Increase coverage of three doses of combined diphtheria-tetanus-pertussis (DTP3) (12-23 months) at annual rate of 3-5% from the baseline of 7% (CES 2009).# Increase ORS use in under-five children with diarrhoea at annual rate of 7[?]2% from the baseline of 43% (CES 2009).# Reduce unmet need for family planning methods among eligible couples, married and unmarried, at annual rate of 8[?]8% from the baseline of 21% (DLHS 3).# Increase met need for modem family planning methods among eligible couples at annual rate of 4[?]5% from the baseline of 47% (DLH 3).# Reduce anaemia in adolescent girls and boys (15-19 years) at annual rate of 6% from the baseline of 56% and 30%, respectively (NFHS-3).# Decrease the proportion of total fertility contributed by adolescents (15-19 years) at annual rate of 3[?]8% per year from the baseline of 16% (NFHS-3).# Raise child sex ratio in the 0-6 years age group at annual of 0[?]6% per year from the baseline of 914 (Census 2011).