National Health Programmes Relevant to OBG Postgraduates (India)

1. National Health Mission (NHM) - The Umbrella Framework

• Launched: 2013 (merged NRHM 2005 + NUHM 2013)
• Objective: Universal access to equitable, affordable, quality healthcare
• Relevance to OBG: All maternal and reproductive health programmes are delivered under the NHM framework
• Sub-missions: NRHM (rural) and NUHM (urban)

2. RMNCH+A / RMNCAH+N Strategy (2013)

• Launched at India's own "Call to Action for Child Survival" summit in February 2013
• Support from USAID-MCHIP, UNICEF, UNFPA
• Operates through 9.15 lakh ASHA workers and a three-tiered health system

• MMR < 100/1,00,000 live births (NHP 2017 target); current MMR = 88 (SRS 2020-22)
• IMR < 25/1,000 live births
• TFR = 2.1 (replacement level); current TFR = 2.0 (achieved)
• NMR ≤ 16 by 2025

3. Key Schemes Under Maternal Health (OBG High-Yield)

A. Janani Suraksha Yojana (JSY)

• Modified NCMS scheme under NHM
• Cash incentive for institutional delivery to reduce MMR and IMR
• Categories: Low Performing States (LPS) vs High Performing States (HPS)
• LPS cash benefit: Rs. 1400 (rural), Rs. 1000 (urban) to mother; Rs. 600 to ASHA
• HPS cash benefit: Rs. 700 (rural), Rs. 600 (urban) to mother

B. Janani Shishu Suraksha Karyakram (JSSK) - 2011

• Free entitlements for pregnant women and sick newborns at public facilities:
  • Free and cashless delivery (including C-section)
  • Free drugs, diagnostics, blood, diet
  • Free transport (home to facility, inter-facility, return)
  • Exemption from out-of-pocket expenses
• Extended to sick newborns up to 30 days after birth

C. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) - 2016

• Fixed day ANC (9th of every month) by specialist/MO
• Minimum guaranteed ANC package on the 4th antenatal visit
• Focus on high-risk pregnant women

D. LaQshya Programme - 2017

• Labour Room Quality Improvement Initiative
• Aims at improving quality of intrapartum and immediate postpartum care
• Prevents preventable maternal and newborn deaths at the time of delivery

E. Surakshit Matritva Aashwasan (SUMAN) - 2019

• Assured, dignified, respectful, and quality healthcare to every woman and newborn
• Zero tolerance for denial of services
• Guarantees: At least 4 ANCs, skilled birth attendance, at least 3 PNC visits

4. Family Planning Programmes

• India was the first country in the world to launch a National Family Planning Programme (1952)
• Evolved: Family Planning (1952) → Family Welfare (1977) → Reproductive & Child Health (RCH, 1997) → RMNCH+A (2013)

• Injectable contraceptive (MPA/Antara) - 3-monthly
• Centrally-supplied OCP (Mala-N)
• Emergency contraceptive (Ezy Pill/I-Pill)
• PPIUCD (within 48 hours of delivery)
• Mini-lap sterilization / NSV
• Chhaya (Centchroman) - weekly pill

5. Comprehensive Abortion Care (CAC)

• Under RMNCH+A/MTP Act
• MTP (Amendment) Act 2021 - key changes:
  • Gestation limit extended from 20 → 24 weeks for special categories (survivors of sexual assault, rape, incest; minors; physically disabled; mentally ill women; fetal abnormality)
  • Up to 20 weeks: Opinion of 1 RMP (previously 1 RMP up to 12 weeks, 2 RMPs up to 20 weeks)
  • 20-24 weeks: Opinion of 2 RMPs
  • Beyond 24 weeks: Only for fetal abnormalities - State Medical Board opinion
  • Upper gestation limit removed for substantial fetal abnormalities
• Medical abortion (MA) with Mifepristone + Misoprostol approved up to 9 weeks (can be extended up to 20 weeks with appropriate regimen)

6. Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 (Amended 2003)

• Prohibits sex determination before or after conception
• Prohibits sex-selective abortion
• Regulates use of ultrasound machines
• 5 criteria for sex determination offence registration
• Punishable with 3-5 years imprisonment + fine
• Registered bodies: Appropriate Authority at district, state, and central level
• Linked to Beti Bachao, Beti Padhao initiative (2015)

7. Reproductive and Child Health Programme (RCH-II)

• Integrated approach replacing vertical programmes
• Components relevant to OBG:
  • Safe motherhood
  • Child survival
  • Family planning
  • Adolescent reproductive health
  • Prevention of RTI/STI

8. Universal Immunization Programme (UIP) - OBG Relevance

• TT (Tetanus Toxoid) / Td vaccine: TT-1 (early pregnancy), TT-2 (4 weeks later), TT Booster (if within 3 years)
• Td replaces TT under Mission Indradhanush
• COVID-19 vaccine: Safe in pregnancy (all trimesters)

• TT/Td protects against neonatal tetanus (MNT elimination target)
• India declared MNT eliminated in 2015 (< 1 case per 1,000 live births per district)

9. National Iron Plus Initiative (NIPI) / Anaemia Mukt Bharat (AMB)

• Addresses anaemia across lifecycle
• Pregnant women: Daily IFA (100 mg elemental iron + 500 mcg folic acid) for 180 days (or throughout pregnancy and 180 days postpartum)
• Adolescent girls (WIFS): Weekly IFA (weekly iron and folic acid supplementation)
• Target: Reduce anaemia prevalence by 3% per year
• 6-by-6-by-6 strategy under AMB

10. Rashtriya Bal Swasthya Karyakram (RBSK) - 2013

• Screening of children from birth to 18 years for 4Ds:
  1. Defects at birth
  2. Deficiencies
  3. Diseases
  4. Developmental delays including disabilities
• Mobile health teams (MHTs) at block level
• Relevant to OBG: Congenital anomaly detection, neonatal screening

11. Skill-Based Training Programmes (Directly Relevant to OBG PGs)

• CEmONC (6 months): Comprehensive Emergency Obstetric and Newborn Care including C-section - for in-service MBBS doctors
• LSAS (6 months): Life Saving Anaesthesia Skills for Emergency Obstetric Care
• BEmOC (10 days): Basic Emergency Obstetric Care for newly recruited MOs
• SBA training (21 days): Skilled Birth Attendant training for ANMs/SNs/LHVs
• Daksh skills labs: Simulation-based training for RMNCH+A services

12. Other Important Programmes

13. Key Indicators to Remember

Exam High-Yield Summary

• First country to launch national family planning programme: India (1952)
• RMNCH+A launched: February 2013
• JSY = cash incentive for institutional delivery; JSSK = free cashless services
• MTP Amendment 2021 - 24 weeks for special categories; 1 RMP up to 20 weeks
• PCPNDT Act - prohibits sex determination; punishment: 3-5 years
• MMR current = 88 (NHP target <100 - achieved); SDG 2030 target = <70
• LaQshya = Labour room quality improvement
• SUMAN = dignified zero-denial maternity care
• TFR 2.0 - India has achieved replacement level fertility