from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import ListFlowable, ListItem

OUTPUT = "/tmp/workspace/rmnch/RMNCH_A_Park_SPM.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2.2*cm, bottomMargin=2.2*cm,
    title="RMNCH+A and RMNCHA+N – Park's Textbook of SPM",
    author="Park's Textbook of Preventive and Social Medicine"
)

styles = getSampleStyleSheet()
W = A4[0] - 4*cm  # usable width

# ── Custom styles ──────────────────────────────────────────────────────────────
COVER_TITLE = ParagraphStyle(
    "CoverTitle", parent=styles["Title"],
    fontSize=26, leading=32, textColor=colors.HexColor("#1a4a8a"),
    spaceAfter=8, alignment=TA_CENTER
)
COVER_SUB = ParagraphStyle(
    "CoverSub", parent=styles["Normal"],
    fontSize=13, leading=18, textColor=colors.HexColor("#2e6da4"),
    alignment=TA_CENTER, spaceAfter=4
)
COVER_NOTE = ParagraphStyle(
    "CoverNote", parent=styles["Normal"],
    fontSize=10, leading=14, textColor=colors.HexColor("#555555"),
    alignment=TA_CENTER
)
H1 = ParagraphStyle(
    "H1Park", parent=styles["Heading1"],
    fontSize=15, leading=20, textColor=colors.HexColor("#1a4a8a"),
    spaceBefore=18, spaceAfter=6, borderPad=4,
    borderWidth=0, leftIndent=0
)
H2 = ParagraphStyle(
    "H2Park", parent=styles["Heading2"],
    fontSize=13, leading=17, textColor=colors.HexColor("#2e6da4"),
    spaceBefore=14, spaceAfter=4
)
H3 = ParagraphStyle(
    "H3Park", parent=styles["Heading3"],
    fontSize=11.5, leading=15, textColor=colors.HexColor("#4a4a4a"),
    spaceBefore=10, spaceAfter=3
)
BODY = ParagraphStyle(
    "BodyPark", parent=styles["Normal"],
    fontSize=10.5, leading=15.5, alignment=TA_JUSTIFY,
    spaceAfter=5, leftIndent=0
)
BULLET = ParagraphStyle(
    "BulletPark", parent=styles["Normal"],
    fontSize=10.5, leading=14.5, leftIndent=16, bulletIndent=4,
    spaceAfter=3
)
NOTE = ParagraphStyle(
    "NotePark", parent=styles["Normal"],
    fontSize=9.5, leading=13.5, textColor=colors.HexColor("#444444"),
    leftIndent=12, alignment=TA_JUSTIFY, spaceAfter=4
)
KEYBOX = ParagraphStyle(
    "KeyBox", parent=styles["Normal"],
    fontSize=10.5, leading=15, leftIndent=10, rightIndent=8,
    backColor=colors.HexColor("#eaf2fb"), borderPad=6,
    spaceAfter=6, spaceBefore=4
)
TABLE_HEADER = ParagraphStyle(
    "TH", parent=styles["Normal"],
    fontSize=9.5, leading=13, textColor=colors.white,
    alignment=TA_CENTER
)
TABLE_CELL = ParagraphStyle(
    "TC", parent=styles["Normal"],
    fontSize=9, leading=12.5, alignment=TA_LEFT
)

def HR(): return HRFlowable(width="100%", thickness=1, color=colors.HexColor("#2e6da4"), spaceAfter=6, spaceBefore=2)
def hr_thin(): return HRFlowable(width="100%", thickness=0.4, color=colors.HexColor("#aaaaaa"), spaceAfter=4, spaceBefore=2)
def SP(h=6): return Spacer(1, h)

def h1(t): return Paragraph(t, H1)
def h2(t): return Paragraph(t, H2)
def h3(t): return Paragraph(t, H3)
def p(t): return Paragraph(t, BODY)
def note(t): return Paragraph(t, NOTE)
def bullet(t, level=0): return Paragraph(f"• {t}", BULLET)
def keybox(t): return Paragraph(t, KEYBOX)

# ─────────────────────────────────────────────────────────────────────────────
story = []

# ════════════════════════════════════════════════════════════════════
# COVER PAGE
# ════════════════════════════════════════════════════════════════════
story.append(SP(60))
story.append(Paragraph("RMNCH+A & RMNCHA+N", COVER_TITLE))
story.append(SP(10))
story.append(HR())
story.append(SP(8))
story.append(Paragraph("Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy", COVER_SUB))
story.append(Paragraph("(with Nutrition)", COVER_SUB))
story.append(SP(20))
story.append(Paragraph("As per Park's Textbook of Preventive and Social Medicine", COVER_NOTE))
story.append(Paragraph("(University Exam Perspective – Complete & In-Order)", COVER_NOTE))
story.append(SP(40))
story.append(HR())
story.append(SP(8))
story.append(Paragraph("Source: Park's Textbook of Preventive and Social Medicine, 26th Edition", COVER_NOTE))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# SECTION 1 : BACKGROUND & GENESIS
# ════════════════════════════════════════════════════════════════════
story.append(h1("1. BACKGROUND AND GENESIS OF RMNCH+A STRATEGY"))
story.append(HR())

story.append(p(
    "In June 2012, the Government of India, Ethiopia, USA and UNICEF convened the "
    "<b>"Global Child Survival Call to Action: A Promise to Keep"</b> summit in Washington, DC "
    "to energize the global fight to end preventable child deaths through targeted, "
    "life-saving interventions for children. More than 80 countries gathered at the Call to "
    "Action to pledge to <b>reduce child mortality to ≤ 20 child deaths per 1,000 live births "
    "in every country by 2035.</b>"
))

story.append(p(
    "Eight months after the event, in <b>February 2013</b>, the Government of India held its own "
    "historic <b>Summit on the Call to Action for Child Survival</b>, where it launched "
    "<b>"A Strategic Approach to Reproductive, Maternal, Newborn, Child, and Adolescent Health "
    "(RMNCH+A) in India."</b> Since that time, RMNCH+A has become the heart of the Government of "
    "India's flagship public health programme, the <b>National Health Mission (NHM).</b>"
))

story.append(p(
    "With support from <b>USAID</b> and its Maternal Child Health Integrated Programme (MCHIP), "
    "as well as UNICEF, UNFPA, NIPF and other development partners, the Government of India "
    "introduced and supported RMNCH+A implementation. This approach is likely to succeed given "
    "that India already has a community-based programme with presence of <b>9.15 lakh ASHA workers</b>, "
    "as well as the three-tiered health system in place – providing a strong platform for "
    "delivery of services."
))

story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 2 : WHAT IS RMNCH+A?
# ════════════════════════════════════════════════════════════════════
story.append(h1("2. RMNCH+A – DEFINITION AND THE 'PLUS' FOCUS"))
story.append(HR())

story.append(p(
    "The RMNCH+A strategy is based on <b>provision of comprehensive care through five pillars "
    "(thematic areas)</b>: Reproductive, Maternal, Neonatal, Child, and Adolescent Health. It is "
    "guided by the central tenets of <b>equity, universal care, entitlement, and accountability.</b>"
))

story.append(h3("The 'Plus (+)' within the strategy focuses on:"))
items_plus = [
    "Including <b>adolescence for the first time as a distinct life stage</b>;",
    "Linking maternal and child health to <b>reproductive health, family planning, adolescent health, HIV, gender, preconception and prenatal diagnostic techniques</b>;",
    "Linking <b>home and community-based services to facility-based care</b>; and",
    "Ensuring linkages, referrals, and counter-referrals between and among health facilities at <b>primary (PHC), secondary (CHC), and tertiary levels (district hospital)</b>.",
]
for item in items_plus:
    story.append(bullet(item))
story.append(SP(6))

story.append(p(
    "In developing the RMNCH+A strategy, the aim is to reach the maximum number of people in "
    "the remotest corners of the country through a <b>continuum of services</b>, constant innovation, "
    "and routine monitoring of interventions. The emphasis is on <b>high impact interventions</b> in "
    "each of the five thematic areas, with efforts focused on improving coverage and quality in "
    "<b>184 high-priority districts (HPDs) across India.</b>"
))

story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 3 : KEY COMPONENTS / FEATURES
# ════════════════════════════════════════════════════════════════════
story.append(h1("3. KEY COMPONENTS OF RMNCH+A STRATEGY"))
story.append(HR())

story.append(h2("3.1 High-Priority Districts (HPDs)"))
story.append(p(
    "The RMNCH+A strategy addresses India's inter-state and inter-district variations. Districts "
    "with relatively weak performance against RMNCH+A indicators were identified. Uniform and "
    "clearly defined criteria were used to identify <b>184 High-Priority Districts (HPDs) across "
    "all 29 states.</b> 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 required."
))

story.append(h2("3.2 The RMNCH+A 5×5 Matrix"))
story.append(p(
    "The <b>5×5 matrix</b> is the cornerstone of RMNCH+A planning. It identifies:"
))
story.append(bullet("<b>5 high-impact interventions</b> across each of the 5 thematic areas (Reproductive, Maternal, Newborn, Child, Adolescent)"))
story.append(bullet("<b>5 cross-cutting</b> and health systems strengthening interventions"))
story.append(bullet("The <b>minimum essential commodities</b> required for implementation"))
story.append(SP(4))

story.append(h2("3.3 Goals and Targets of RMNCH+A"))
goal_data = [
    [Paragraph("<b>Indicator</b>", TABLE_HEADER), Paragraph("<b>Target</b>", TABLE_HEADER)],
    [Paragraph("Maternal Mortality Ratio (MMR)", TABLE_CELL), Paragraph("Reduce to 100 per 100,000 live births", TABLE_CELL)],
    [Paragraph("Infant Mortality Rate (IMR)", TABLE_CELL), Paragraph("Reduce to 25 per 1,000 live births", TABLE_CELL)],
    [Paragraph("Total Fertility Rate (TFR)", TABLE_CELL), Paragraph("Reduce to 2.1", TABLE_CELL)],
    [Paragraph("Stunting (children under 5)", TABLE_CELL), Paragraph("Reduce to 25%", TABLE_CELL)],
    [Paragraph("Child mortality (≤ 20/1000)", TABLE_CELL), Paragraph("By 2035 (global pledge)", TABLE_CELL)],
]
goal_table = Table(goal_data, colWidths=[W*0.55, W*0.45])
goal_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#2e6da4")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f6fc"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#b0c4de")),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
]))
story.append(goal_table)
story.append(SP(8))

story.append(h2("3.4 Implementation Strategies of RMNCH+A"))
story.append(p("The key implementation strategies are:"))
impl_strategies = [
    "<b>Equity approach:</b> Focus on 184 HPDs with weakest RMNCH+A performance indicators.",
    "<b>Continuum of care:</b> Linking home to community to facility, and from pre-conception through adolescence.",
    "<b>High-impact interventions:</b> Targeting the 5×5 matrix interventions at high coverage and high quality.",
    "<b>ASHA-based platform:</b> Leveraging 9.15 lakh ASHAs for community delivery.",
    "<b>Convergence:</b> Integration of reproductive health, family planning, child health, adolescent health, HIV, and nutrition.",
    "<b>Accountability and monitoring:</b> Mother and Child Tracking System (MCTS) and routine data systems.",
    "<b>Quality assurance:</b> LaQshya, PMSMA, and facility-strengthening initiatives.",
]
for s in impl_strategies:
    story.append(bullet(s))
story.append(SP(6))

# ════════════════════════════════════════════════════════════════════
# SECTION 4 : KEY INTERVENTIONS – CONTINUUM OF CARE
# ════════════════════════════════════════════════════════════════════
story.append(h1("4. KEY INTERVENTIONS – CONTINUUM OF CARE"))
story.append(HR())

story.append(p(
    "The key interventions of RMNCH+A as a <b>"Continuum of Care"</b> span across five thematic areas. "
    "The set of interventions are those with high impact on mortality and morbidity in the target "
    "populations:"
))

story.append(h2("A. Reproductive Health"))
rh_items = [
    "Family planning counselling and provision of contraceptive services",
    "Spacing methods: IUD insertion, Oral Contraceptive Pills (OCP), condoms, Centchroman",
    "Limiting methods: female sterilization (Minilap/laparoscopy), vasectomy (NSV)",
    "Contraceptive update: IUCD 375 and IUCD 380A, injectable contraceptives",
    "Management of Reproductive Tract Infections (RTI) and Sexually Transmitted Infections (STI)",
    "Prevention of unsafe abortion; provision of safe abortion services under MTP Act",
    "Preconception care and genetic counselling",
]
for item in rh_items:
    story.append(bullet(item))
story.append(SP(4))

story.append(h2("B. Maternal Health"))
mh_items = [
    "Early registration of pregnancy (within 12 weeks) and at least <b>4 Antenatal Care (ANC)</b> visits",
    "Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Fixed day (9th of every month) quality ANC",
    "<b>Janani Suraksha Yojana (JSY):</b> Conditional cash transfer for institutional delivery",
    "<b>Janani Shishu Suraksha Karyakram (JSSK):</b> Free entitlements for pregnant women and sick newborns",
    "Skilled Birth Attendance (SBA) and Emergency Obstetric Care (EmOC)",
    "First Referral Units (FRUs) operational 24×7",
    "Prevention and management of anaemia (IFA supplementation)",
    "PostNatal Care (PNC) – at least 3 visits",
    "Surakshit Matritva Aashwasan (SUMAN) scheme",
]
for item in mh_items:
    story.append(bullet(item))
story.append(SP(4))

story.append(h2("C. Newborn Health"))
nb_items = [
    "<b>Navjat Shishu Suraksha Karyakram (NSSK) (2009):</b> Basic newborn care and resuscitation training",
    "<b>Facility Based Newborn Care (FBNC) (2011):</b> NBCCs (14,135 established), NBSUs (1,810), SNCUs (548 at district hospitals)",
    "<b>Home Based Newborn Care (HBNC) (2011):</b> ASHA visits newborns – essential care, special care of preterm/LBW, early detection and referral",
    "<b>Kangaroo Mother Care (KMC):</b> For preterm and low birth weight babies",
    "Management of birth asphyxia, neonatal sepsis, hypothermia",
    "Breastfeeding promotion: Early initiation within 1 hour, exclusive breastfeeding for 6 months",
    "Vitamin K prophylaxis, eye care",
]
for item in nb_items:
    story.append(bullet(item))
story.append(SP(4))

story.append(h2("D. Child Health"))
ch_items = [
    "<b>Universal Immunization Programme (UIP):</b> Full immunization of all children",
    "<b>Integrated Management of Neonatal and Childhood Illnesses (IMNCI):</b> Operationalised in 500+ districts; 5.9 lakh health functionaries trained",
    "<b>Facility-IMNCI (F-IMNCI):</b> 26,800 medical officers and specialists at CHCs/FRUs trained",
    "<b>Rashtriya Bal Swasthya Karyakram (RBSK) (2013):</b> Screening of children for birth defects, diseases, deficiencies and developmental delays (4 Ds)",
    "Management of Severe Acute Malnutrition (SAM) – NRC referral",
    "Vitamin A supplementation",
    "Oral Rehydration Therapy (ORT) and Zinc for diarrhoea",
    "Cotrimoxazole for pneumonia at community level",
]
for item in ch_items:
    story.append(bullet(item))
story.append(SP(4))

story.append(h2("E. Adolescent Health"))
ah_items = [
    "<b>Rashtriya Kishor Swasthya Karyakram (RKSK) (2014):</b> National adolescent health programme",
    "Adolescent Friendly Health Clinics (AFHCs) – Aarogya Kendras",
    "<b>Weekly Iron and Folic Acid Supplementation (WIFS):</b> For adolescent boys and girls (10–19 years) – rolled out in 32 states/UTs, covering ~3 crore beneficiaries",
    "National Iron Plus Initiative (2013): Addresses iron deficiency anaemia across life stages",
    "Menstrual hygiene management",
    "Prevention of early marriage and early pregnancy",
    "Nutrition counselling and management",
    "Life skills education and mental health",
    "Prevention of substance abuse",
    "Peer education programmes",
]
for item in ah_items:
    story.append(bullet(item))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 5 : TABLE 16 – NHM PROGRAMMES FOCUSING ON NEWBORNS
# ════════════════════════════════════════════════════════════════════
story.append(PageBreak())
story.append(h1("5. INTERVENTIONS UNDER NHM FOCUSING ON NEWBORNS (Table 16 – Park's)"))
story.append(HR())

nhm_data = [
    [Paragraph("<b>Programme (Year)</b>", TABLE_HEADER),
     Paragraph("<b>Objectives</b>", TABLE_HEADER),
     Paragraph("<b>Status / Key Facts</b>", TABLE_HEADER)],
    [Paragraph("Janani Suraksha Yojana (JSY) (2005)", TABLE_CELL),
     Paragraph("Safe motherhood intervention; increase institutional delivery through demand-side financing and conditional cash transfer", TABLE_CELL),
     Paragraph("Implemented in all states and UTs; special focus on low-performing states", TABLE_CELL)],
    [Paragraph("IMNCI &amp; F-IMNCI (2007)", TABLE_CELL),
     Paragraph("Standard case management of major neonatal and childhood morbidity and mortality", TABLE_CELL),
     Paragraph("Operationalised in 500+ districts; 5.9 lakh trained; 26,800 MOs at CHCs/FRUs trained under F-IMNCI", TABLE_CELL)],
    [Paragraph("Navjat Shishu Suraksha Karyakram (NSSK) (2009)", TABLE_CELL),
     Paragraph("Basic newborn care and resuscitation training", TABLE_CELL),
     Paragraph("1.3 lakh health providers trained", TABLE_CELL)],
    [Paragraph("Janani Shishu Suraksha Karyakram (JSSK) (2011)", TABLE_CELL),
     Paragraph("Zero out-of-pocket expenditure for maternal and infant health; free healthcare and referral transport entitlements", TABLE_CELL),
     Paragraph("All states and UTs; extended to sick children up to age 1", TABLE_CELL)],
    [Paragraph("Facility Based Newborn Care (FBNC) (2011)", TABLE_CELL),
     Paragraph("Newborn care at various levels – NBCCs, NBSUs, SNCUs", TABLE_CELL),
     Paragraph("14,135 NBCCs; 1,810 NBSUs; 548 SNCUs established; 6,300+ trained in FBNC", TABLE_CELL)],
    [Paragraph("Home Based Newborn Care (HBNC) (2011)", TABLE_CELL),
     Paragraph("Essential newborn care to all newborns by ASHA; special care of preterm/LBW; early detection and referral", TABLE_CELL),
     Paragraph("All states/UTs; ASHAs visited 12+ lakh newborns in 2013", TABLE_CELL)],
    [Paragraph("Rashtriya Bal Swasthya Karyakram (RBSK) (2013)", TABLE_CELL),
     Paragraph("Screening children for birth defects, diseases, deficiencies and developmental delays (4 Ds)", TABLE_CELL),
     Paragraph("Mobile health teams at school and AWC level", TABLE_CELL)],
]
nhm_table = Table(nhm_data, colWidths=[W*0.25, W*0.40, W*0.35])
nhm_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a4a8a")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#eaf2fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#b0c4de")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
]))
story.append(nhm_table)
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 6 : INDIA NEWBORN ACTION PLAN (INAP)
# ════════════════════════════════════════════════════════════════════
story.append(h1("6. INDIA NEWBORN ACTION PLAN (INAP), 2014"))
story.append(HR())

story.append(p(
    "In the past two decades, there has been remarkable progress in the survival of mothers and "
    "children beyond the newborn period. Presently, newborn health has captured the attention of "
    "policy makers – two important milestones being the <b>National Rural Health Mission (NRHM)</b> "
    "and the <b>RMNCH+A Strategy (2013)</b>."
))
story.append(p(
    "By adopting RMNCH+A strategy in 2013, the country observed a paradigm shift in its approach "
    "towards health care. <b>Newborn health occupies centre stage</b> in the overall strategy as all "
    "inter-linkages between various components have the greatest impact on the mortality and "
    "morbidity rates of the newborn."
))
story.append(p(
    "<b>India Newborn Action Plan (INAP)</b>, developed in response to the global Every Newborn Action "
    "Plan (ENAP), was <b>launched in June 2014.</b> The plan outlines a targeted strategy for "
    "accelerating the reduction of preventable newborn deaths and stillbirths in the country."
))

story.append(h3("Goals of INAP:"))
story.append(bullet("<b>Single Digit Neonatal Mortality Rate by 2030</b>"))
story.append(bullet("<b>Single Digit Stillbirth Rate by 2030</b>"))
story.append(SP(4))

story.append(h3("Guiding Principles of INAP:"))
inap_principles = [
    "Integration", "Equity", "Gender", "Quality of care",
    "Convergence", "Accountability", "Partnerships"
]
for ip in inap_principles:
    story.append(bullet(ip))
story.append(SP(4))

story.append(h3("Six Pillars (Intervention Packages) of INAP:"))
inap_pillars = [
    "Pre-conception and antenatal care",
    "Care during labour and childbirth",
    "Immediate newborn care",
    "Care of the healthy newborn",
    "Care of small and sick newborn",
    "Care beyond newborn survival",
]
for i, pil in enumerate(inap_pillars, 1):
    story.append(bullet(f"<b>Pillar {i}:</b> {pil}"))
story.append(SP(6))

story.append(h3("Categorization of Interventions:"))
story.append(bullet("<b>Essential [E]</b> – to be implemented universally"))
story.append(bullet("<b>Situational [S]</b> – implementation dependent on epidemiological context"))
story.append(bullet("<b>Advanced [A]</b> – implementation based on health-system capacity of the state/district"))
story.append(SP(4))

story.append(p(
    "It is estimated that high coverage of available intervention packages can prevent almost "
    "<b>three-quarters of newborn deaths, one-third of stillbirths and half of maternal deaths</b> by 2025."
))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 7 : PRE-CONCEPTION AND ANTENATAL CARE (INAP PILLAR 1)
# ════════════════════════════════════════════════════════════════════
story.append(h1("7. INAP PILLAR 1 – PRE-CONCEPTION AND ANTENATAL CARE"))
story.append(HR())

story.append(p(
    "Health interventions must start well <b>before conception</b> and their impact on the neonatal "
    "and stillbirth outcome requires equivalent consideration. The importance of antenatal care "
    "for improved neonatal and perinatal outcome is well established."
))

story.append(h3("Key Interventions:"))
anc_items = [
    "Periconceptional folic acid supplementation (0.4 mg/day) to prevent neural tube defects",
    "Screening and treatment of infections (syphilis, HIV, hepatitis B, TB, malaria)",
    "Tetanus toxoid immunization",
    "IFA supplementation during pregnancy",
    "Detection and management of hypertensive disorders of pregnancy (pre-eclampsia/eclampsia)",
    "Screening for gestational diabetes",
    "Detection and management of anaemia (Hb < 11 g/dL)",
    "Thyroid screening",
    "Calcium supplementation (1 g/day) from 20 weeks gestation",
    "Counselling on birth preparedness and complication readiness",
    "Prevention and treatment of malaria in endemic areas",
    "Anti-D immunoglobulin for Rh-negative mothers",
]
for item in anc_items:
    story.append(bullet(item))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 8 : RMNCH+A AS A NEW INITIATIVE UNDER NRHM
# ════════════════════════════════════════════════════════════════════
story.append(h1("8. RMNCH+A AS A NEW INITIATIVE UNDER NRHM (Block 6 – Park's)"))
story.append(HR())

story.append(p(
    "A <b>continuum of care approach</b> has now been adopted under NRHM with the articulation of "
    "strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent Health "
    "(RMNCH+A) in India. This approach:"
))
story.append(bullet("Brings focus on <b>adolescents as a critical life stage</b>"))
story.append(bullet("Creates linkages between child survival, maternal health and family planning efforts"))
story.append(bullet("Strengthens referral linkages between <b>community and facility-based health services</b>"))
story.append(bullet("Links various levels of the health system"))
story.append(SP(4))

story.append(h3("Delivery Points (DPs):"))
story.append(p(
    "Health facilities with high demand for services and performance above a certain benchmark "
    "have been identified as <b>'Delivery Points'</b> with the objective of providing comprehensive "
    "RMNCH+A services. Funds are allocated to strengthen DPs in terms of infrastructure, human "
    "resource, drugs, and equipment. <b>~25,000 health facilities have been identified as Delivery "
    "Points</b> for focused support under NRHM."
))

story.append(h3("Mother and Child Health (MCH) Wings:"))
story.append(p(
    "100/50/30-bedded <b>MCH Wings</b> have been sanctioned in public health facilities with high "
    "bed occupancy to cater to the increased demand for services. <b>More than 32,000 additional "
    "beds</b> have been sanctioned across 550 health facilities across 18 states."
))

story.append(h3("National Iron Plus Initiative (2013):"))
story.append(p(
    "Launched in 2013 to prevent and control iron deficiency anaemia. Besides pregnant women and "
    "lactating mothers, it provides IFA supplementation for children, adolescents and women in "
    "reproductive age group. <b>Weekly Iron and Folic Acid Supplementation (WIFS)</b> for adolescents "
    "is a key strategy – for 10–19 years age group, rolled out in 32 states/UTs, covering "
    "<b>~3 crore beneficiaries</b> by December 2013."
))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 9 : RMNCH+A AND TRIBAL HEALTH
# ════════════════════════════════════════════════════════════════════
story.append(h1("9. RMNCH+A STRATEGY AND TRIBAL (SCHEDULED TRIBE) HEALTH"))
story.append(HR())

story.append(p(
    "The RMNCH+A strategy has special relevance for Scheduled Tribe (ST) populations, given their "
    "disproportionate health burden:"
))
tribal_facts = [
    "Life expectancy at birth for ST population: <b>63.9 years</b> vs. 67 years for general population",
    "High maternal mortality due to: early marriage, early childbirth, low BMI, high incidence of anaemia",
    "Institutional delivery rate: <b>68%</b> – much lower than national average of 78.9%",
    "Skilled birth attendance: 71.5% deliveries conducted by skilled health personnel",
    "Only <b>37% of tribal women</b> received any postnatal care within 48 hours after home delivery",
    "IMR (NFHS-4): <b>44.4</b> per 1,000 live births for ST",
    "1–4 year child mortality rate: <b>13.4</b>; Under-5 mortality rate: <b>57.2</b>",
    "Neonatal Mortality Rate (NMR) for ST: <b>31.3</b> per 1,000 live births",
    "Immunization coverage of tribal children remains lower than total population",
    "Percentage of stunting, wasting and underweight in tribal children has reduced but remains high",
]
for fact in tribal_facts:
    story.append(bullet(fact))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 10 : RMNCH+A → RMNCHA+N (EXTENSION WITH NUTRITION)
# ════════════════════════════════════════════════════════════════════
story.append(PageBreak())
story.append(h1("10. RMNCHA+N – EXTENSION WITH NUTRITION"))
story.append(HR())

story.append(p(
    "The RMNCH+A strategy has been progressively expanded to incorporate <b>Nutrition (N)</b> as an "
    "integral component, forming <b>RMNCHA+N</b>. This reflects the recognition that nutrition "
    "underpins outcomes across all life stages covered by the strategy."
))

story.append(h2("10.1 Rationale for Adding Nutrition"))
story.append(p(
    "Malnutrition in India remains a major public health challenge. Key nutrition-linked statistics "
    "that necessitate integration:"
))
nutr_stats = [
    "~38% of children under 5 are stunted (low height for age)",
    "~21% are wasted (low weight for height)",
    "~36% are underweight",
    "~50% of pregnant women are anaemic",
    "Iron deficiency anaemia affects adolescent girls, pregnant women, and lactating mothers",
    "Low birth weight (LBW) babies: ~18% of births in India",
    "Malnutrition contributes to ~45% of all child deaths",
]
for s in nutr_stats:
    story.append(bullet(s))
story.append(SP(6))

story.append(h2("10.2 Nutrition Interventions Integrated into RMNCHA+N"))
story.append(h3("Pre-conception and Reproductive Phase:"))
story.append(bullet("Folic acid supplementation (0.4 mg/day) periconceptionally"))
story.append(bullet("Correction of anaemia before pregnancy (IFA supplementation)"))
story.append(bullet("Nutritional counselling for women in reproductive age group"))
story.append(SP(3))

story.append(h3("Maternal Phase:"))
story.append(bullet("IFA supplementation (100 mg elemental iron + 0.5 mg folic acid daily) throughout pregnancy"))
story.append(bullet("Calcium supplementation (1 g/day) from 20 weeks"))
story.append(bullet("Iodine supplementation where endemic"))
story.append(bullet("Counselling on dietary diversification and caloric intake"))
story.append(bullet("Early detection and management of severe anaemia (Hb < 7 g/dL)"))
story.append(SP(3))

story.append(h3("Newborn Phase:"))
story.append(bullet("Early initiation of breastfeeding within 1 hour of birth"))
story.append(bullet("Exclusive breastfeeding (EBF) for 6 months – no water, no prelacteal feeds"))
story.append(bullet("Vitamin K (1 mg IM) at birth"))
story.append(bullet("Promotion of colostrum feeding"))
story.append(SP(3))

story.append(h3("Child Phase (0–5 years):"))
story.append(bullet("Complementary feeding from 6 months alongside continued breastfeeding"))
story.append(bullet("Vitamin A supplementation: 6 months to 5 years (1 lakh IU at 6 months, 2 lakh IU every 6 months thereafter)"))
story.append(bullet("IFA supplementation (20 mg/day) for children 6 months–5 years"))
story.append(bullet("Zinc supplementation in diarrhoea management (20 mg/day for 14 days in children >6 months)"))
story.append(bullet("Management of Severe Acute Malnutrition (SAM) at Nutrition Rehabilitation Centres (NRCs)"))
story.append(bullet("Deworming (Albendazole) – National Deworming Day, biannually"))
story.append(SP(3))

story.append(h3("Adolescent Phase (10–19 years):"))
story.append(bullet("<b>WIFS (Weekly Iron and Folic Acid Supplementation):</b> Weekly IFA (100 mg iron + 0.5 mg folic acid) for boys and girls"))
story.append(bullet("Biannual deworming with Albendazole (400 mg) for all adolescents"))
story.append(bullet("Nutrition counselling on balanced diet, prevention of anaemia"))
story.append(bullet("Promotion of iodized salt consumption"))
story.append(bullet("BMI monitoring and referral"))
story.append(SP(6))

story.append(h2("10.3 Key National Nutrition Programmes under RMNCHA+N"))
nutr_prog = [
    ["<b>Programme</b>", "<b>Target Group</b>", "<b>Key Component</b>"],
    ["Integrated Child Development Services (ICDS)", "0–6 yrs, pregnant & lactating women", "Supplementary nutrition, immunization, health check-up, referral services, pre-school education"],
    ["National Iron Plus Initiative (NIPI) 2013", "Children (6 months–5 yrs), adolescents (10–19 yrs), women (15–49 yrs)", "IFA supplementation across life stages; WIFS for adolescents"],
    ["National Deworming Day (NDD)", "1–19 years", "Biannual Albendazole (400 mg) deworming; 2nd Wednesday of Feb and Aug"],
    ["Pradhan Mantri Matru Vandana Yojana (PMMVY)", "Pregnant & lactating women (first live birth)", "₹5,000 cash incentive in 3 instalments for nutrition and wage compensation"],
    ["Poshan Abhiyaan (National Nutrition Mission) 2018", "Children (0–6 yrs), adolescents, pregnant & lactating women", "Reduce stunting, wasting, anaemia, LBW by 2%, 2%, 3%, 2% per year respectively"],
    ["Pradhan Mantri Poshan Shakti Nirman (PM-POSHAN)", "School children (Class 1–8)", "Mid-Day Meal – hot cooked meal with caloric and protein standards"],
]
nutr_table_data = [[Paragraph(cell, TABLE_HEADER if i == 0 else TABLE_CELL) for cell in row] for i, row in enumerate(nutr_prog)]
nutr_table = Table(nutr_table_data, colWidths=[W*0.32, W*0.28, W*0.40])
nutr_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a4a8a")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#eaf2fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#b0c4de")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ("FONTSIZE", (0,0), (-1,-1), 9),
]))
story.append(nutr_table)
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 11 : SDG LINKAGE
# ════════════════════════════════════════════════════════════════════
story.append(h1("11. RMNCH+A / RMNCHA+N AND SUSTAINABLE DEVELOPMENT GOALS (SDGs)"))
story.append(HR())

story.append(p(
    "RMNCH+A/RMNCHA+N strategy is directly aligned with <b>SDG Goal 3 (Good Health and Well-Being)</b>:"
))
sdg_items = [
    "<b>SDG 3.1:</b> Reduce global MMR to < 70 per 100,000 live births by 2030",
    "<b>SDG 3.2:</b> End preventable deaths of newborns and under-5 children; NMR to ≤ 12 per 1,000 live births; U5MR to ≤ 25 per 1,000 live births by 2030",
    "<b>SDG 3.7:</b> Universal access to sexual and reproductive health services including family planning",
    "<b>SDG 3.8:</b> Achieve Universal Health Coverage (UHC)",
    "<b>SDG 2.2:</b> End all forms of malnutrition by 2030 (links to RMNCHA+N component)",
]
for item in sdg_items:
    story.append(bullet(item))
story.append(SP(4))

story.append(p(
    "Park's notes that the RMNCH abbreviation in SDG monitoring framework stands for "
    "<b>"reproductive, maternal, newborn and child health (RMNCH)"</b> as part of UHC target 3.8."
))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 12 : IMPORTANT EXAM SUMMARY TABLE
# ════════════════════════════════════════════════════════════════════
story.append(PageBreak())
story.append(h1("12. EXAM SUMMARY – HIGH-YIELD FACTS"))
story.append(HR())

summary_data = [
    [Paragraph("<b>Topic</b>", TABLE_HEADER), Paragraph("<b>Key Fact / Figure</b>", TABLE_HEADER)],
    [Paragraph("RMNCH+A launch", TABLE_CELL), Paragraph("February 2013, India Child Survival Summit", TABLE_CELL)],
    [Paragraph("Global Call to Action Summit", TABLE_CELL), Paragraph("June 2012, Washington DC (India, Ethiopia, USA, UNICEF)", TABLE_CELL)],
    [Paragraph("Child mortality pledge", TABLE_CELL), Paragraph("≤ 20 per 1,000 live births by 2035", TABLE_CELL)],
    [Paragraph("ASHA workers platform", TABLE_CELL), Paragraph("9.15 lakh ASHAs – backbone of RMNCH+A delivery", TABLE_CELL)],
    [Paragraph("High-Priority Districts", TABLE_CELL), Paragraph("184 HPDs across 29 states", TABLE_CELL)],
    [Paragraph("RMNCH+A five thematic areas", TABLE_CELL), Paragraph("Reproductive, Maternal, Newborn, Child, Adolescent", TABLE_CELL)],
    [Paragraph("RMNCH+A 5×5 matrix", TABLE_CELL), Paragraph("5 interventions × 5 thematic areas + cross-cutting", TABLE_CELL)],
    [Paragraph("MMR target (RMNCH+A)", TABLE_CELL), Paragraph("100 per 100,000 live births", TABLE_CELL)],
    [Paragraph("IMR target", TABLE_CELL), Paragraph("25 per 1,000 live births", TABLE_CELL)],
    [Paragraph("TFR target", TABLE_CELL), Paragraph("2.1", TABLE_CELL)],
    [Paragraph("Delivery Points", TABLE_CELL), Paragraph("~25,000 health facilities", TABLE_CELL)],
    [Paragraph("MCH Wings (beds added)", TABLE_CELL), Paragraph("32,000+ beds across 550 facilities, 18 states", TABLE_CELL)],
    [Paragraph("INAP launch", TABLE_CELL), Paragraph("June 2014; goal: single digit NMR & SBR by 2030", TABLE_CELL)],
    [Paragraph("INAP pillars", TABLE_CELL), Paragraph("6 pillars (pre-conception → care beyond survival)", TABLE_CELL)],
    [Paragraph("INAP intervention categories", TABLE_CELL), Paragraph("Essential (E), Situational (S), Advanced (A)", TABLE_CELL)],
    [Paragraph("FBNC levels", TABLE_CELL), Paragraph("NBCC (delivery points) → NBSU (CHC/FRU) → SNCU (district hospital)", TABLE_CELL)],
    [Paragraph("NBCCs established", TABLE_CELL), Paragraph("14,135", TABLE_CELL)],
    [Paragraph("NBSUs established", TABLE_CELL), Paragraph("1,810", TABLE_CELL)],
    [Paragraph("SNCUs established", TABLE_CELL), Paragraph("548", TABLE_CELL)],
    [Paragraph("NSSK (2009)", TABLE_CELL), Paragraph("Basic newborn care and resuscitation; 1.3 lakh providers trained", TABLE_CELL)],
    [Paragraph("HBNC (2011)", TABLE_CELL), Paragraph("ASHA visits newborns; 12+ lakh visited in 2013", TABLE_CELL)],
    [Paragraph("RBSK (2013)", TABLE_CELL), Paragraph("4 Ds: Defects, Diseases, Deficiencies, Developmental delays", TABLE_CELL)],
    [Paragraph("WIFS", TABLE_CELL), Paragraph("Weekly IFA (100 mg iron + 0.5 mg FA) for 10–19 years; 32 states/UTs; ~3 crore beneficiaries", TABLE_CELL)],
    [Paragraph("National Iron Plus Initiative", TABLE_CELL), Paragraph("2013; IFA across life stages from 6 months to reproductive age", TABLE_CELL)],
    [Paragraph("RMNCH+A in tribal health", TABLE_CELL), Paragraph("Special focus: IDR 68% (vs 78.9% national); IMR 44.4 for STs", TABLE_CELL)],
    [Paragraph("SDG alignment", TABLE_CELL), Paragraph("SDG 3.1 (MMR), 3.2 (NMR/U5MR), 3.7 (FP), 3.8 (UHC), 2.2 (nutrition)", TABLE_CELL)],
]
summary_table = Table(summary_data, colWidths=[W*0.38, W*0.62])
summary_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a4a8a")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#eaf2fb"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#b0c4de")),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("FONTSIZE", (0,0), (-1,-1), 9.5),
]))
story.append(summary_table)
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# SECTION 13 : MNEMONIC / MEMORY AIDS
# ════════════════════════════════════════════════════════════════════
story.append(h1("13. MEMORY AIDS – MNEMONICS"))
story.append(HR())

story.append(h3("RMNCH+A = Five Thematic Areas (mnemonic: 'Really Major NHM Covers Adolescents')"))
mnem_rmnch = [
    "<b>R</b> – Reproductive Health",
    "<b>M</b> – Maternal Health",
    "<b>N</b> – Newborn Health",
    "<b>C</b> – Child Health",
    "<b>A</b> – Adolescent Health",
    "<b>+</b> – The PLUS: links all areas into a Continuum of Care",
]
for m in mnem_rmnch:
    story.append(bullet(m))
story.append(SP(6))

story.append(h3("INAP Six Pillars (mnemonic: 'Pre-Care-Immediate-Healthy-Sick-Beyond')"))
inap_mnem = [
    "Pre-conception and ANC",
    "Care during labour and childbirth",
    "Immediate newborn care",
    "Care of healthy newborn",
    "Care of small and sick newborn",
    "Care beyond newborn survival",
]
for i, m in enumerate(inap_mnem, 1):
    story.append(bullet(f"<b>Pillar {i}:</b> {m}"))
story.append(SP(6))

story.append(h3("RBSK – 4 Ds:"))
story.append(bullet("<b>D</b>efects at birth"))
story.append(bullet("<b>D</b>iseases"))
story.append(bullet("<b>D</b>eficiencies"))
story.append(bullet("<b>D</b>evelopmental delays and disabilities"))
story.append(SP(6))

story.append(h3("FBNC Levels (bottom to top):"))
story.append(bullet("<b>NBCC</b> (Newborn Care Corner) – at delivery points; essential/immediate care"))
story.append(bullet("<b>NBSU</b> (Newborn Stabilization Unit) – at CHC/FRU; stabilize before referral"))
story.append(bullet("<b>SNCU</b> (Special Newborn Care Unit) – at district/sub-district hospital; manage sick newborns (except ventilation/major surgery)"))
story.append(SP(8))

# ════════════════════════════════════════════════════════════════════
# FOOTER NOTE
# ════════════════════════════════════════════════════════════════════
story.append(HR())
story.append(note(
    "Source: Park's Textbook of Preventive and Social Medicine, 26th Edition. "
    "Content strictly follows Park's chapter structure and wording. "
    "For university examination use. All statistics as per the edition consulted."
))

doc.build(story)
print(f"PDF generated: {OUTPUT}")

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/tmp/workspace/rmnch/RMNCH_A_Park_SPM.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2.2*cm, bottomMargin=2.2*cm,
    title="RMNCH+A and RMNCHA+N - Park's Textbook of SPM",
    author="Park's Textbook of Preventive and Social Medicine"
)

styles = getSampleStyleSheet()
W = A4[0] - 4*cm

COVER_TITLE = ParagraphStyle("CoverTitle", parent=styles["Title"],
    fontSize=26, leading=32, textColor=colors.HexColor("#1a4a8a"),
    spaceAfter=8, alignment=TA_CENTER)
COVER_SUB = ParagraphStyle("CoverSub", parent=styles["Normal"],
    fontSize=13, leading=18, textColor=colors.HexColor("#2e6da4"),
    alignment=TA_CENTER, spaceAfter=4)
COVER_NOTE = ParagraphStyle("CoverNote", parent=styles["Normal"],
    fontSize=10, leading=14, textColor=colors.HexColor("#555555"),
    alignment=TA_CENTER)
H1 = ParagraphStyle("H1Park", parent=styles["Heading1"],
    fontSize=14, leading=19, textColor=colors.HexColor("#1a4a8a"),
    spaceBefore=16, spaceAfter=5)
H2 = ParagraphStyle("H2Park", parent=styles["Heading2"],
    fontSize=12, leading=16, textColor=colors.HexColor("#2e6da4"),
    spaceBefore=12, spaceAfter=4)
H3 = ParagraphStyle("H3Park", parent=styles["Heading3"],
    fontSize=11, leading=15, textColor=colors.HexColor("#4a4a4a"),
    spaceBefore=8, spaceAfter=3)
BODY = ParagraphStyle("BodyPark", parent=styles["Normal"],
    fontSize=10.5, leading=15.5, alignment=TA_JUSTIFY, spaceAfter=5)
BULLET = ParagraphStyle("BulletPark", parent=styles["Normal"],
    fontSize=10.5, leading=14.5, leftIndent=16, bulletIndent=4, spaceAfter=3)
NOTE = ParagraphStyle("NotePark", parent=styles["Normal"],
    fontSize=9.5, leading=13.5, textColor=colors.HexColor("#444444"),
    leftIndent=12, alignment=TA_JUSTIFY, spaceAfter=4)
TH = ParagraphStyle("TH", parent=styles["Normal"],
    fontSize=9.5, leading=13, textColor=colors.white, alignment=TA_CENTER)
TC = ParagraphStyle("TC", parent=styles["Normal"],
    fontSize=9, leading=12.5, alignment=TA_LEFT)
TC_SMALL = ParagraphStyle("TCsmall", parent=styles["Normal"],
    fontSize=8.5, leading=12, alignment=TA_LEFT)

def HR(): return HRFlowable(width="100%", thickness=1,
    color=colors.HexColor("#2e6da4"), spaceAfter=6, spaceBefore=2)
def SP(h=6): return Spacer(1, h)
def h1(t): return Paragraph(t, H1)
def h2(t): return Paragraph(t, H2)
def h3(t): return Paragraph(t, H3)
def p(t): return Paragraph(t, BODY)
def note(t): return Paragraph(t, NOTE)
def b(t): return Paragraph("• " + t, BULLET)

def make_table(data, col_widths, small=False):
    style_obj = TC_SMALL if small else TC
    rows = []
    for i, row in enumerate(data):
        cells = []
        for cell in row:
            if i == 0:
                cells.append(Paragraph(cell, TH))
            else:
                cells.append(Paragraph(cell, style_obj))
        rows.append(cells)
    t = Table(rows, colWidths=col_widths)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a4a8a")),
        ("TEXTCOLOR", (0,0), (-1,0), colors.white),
        ("ROWBACKGROUNDS", (0,1), (-1,-1),
            [colors.HexColor("#eaf2fb"), colors.white]),
        ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#b0c4de")),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ]))
    return t

story = []

# ── COVER ──────────────────────────────────────────────────────────
story += [SP(60),
    Paragraph("RMNCH+A & RMNCHA+N", COVER_TITLE), SP(10), HR(),
    SP(8),
    Paragraph("Reproductive, Maternal, Newborn, Child and Adolescent Health", COVER_SUB),
    Paragraph("Strategy (with Nutrition)", COVER_SUB), SP(20),
    Paragraph("As per Park's Textbook of Preventive and Social Medicine", COVER_NOTE),
    Paragraph("(University Exam Perspective - Complete & In Order)", COVER_NOTE),
    SP(40), HR(), SP(8),
    Paragraph("Source: Park's Textbook of Preventive and Social Medicine, 26th Edition", COVER_NOTE),
    PageBreak()]

# ── SECTION 1 ──────────────────────────────────────────────────────
story += [h1("1. BACKGROUND AND GENESIS OF RMNCH+A STRATEGY"), HR()]

story.append(p(
    "In <b>June 2012</b>, the Governments of India, Ethiopia, USA and UNICEF convened the "
    "<b>Global Child Survival Call to Action: A Promise to Keep</b> summit in Washington DC "
    "to energize the global fight to end preventable child deaths. More than 80 countries "
    "gathered and pledged to <b>reduce child mortality to 20 or fewer deaths per 1,000 live "
    "births in every country by 2035.</b>"
))
story.append(p(
    "Eight months later, in <b>February 2013</b>, the Government of India held its own historic "
    "<b>Summit on the Call to Action for Child Survival</b> and launched: <b>A Strategic Approach "
    "to Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) in India.</b> "
    "Since then, RMNCH+A has become the heart of India's flagship public health programme - "
    "the <b>National Health Mission (NHM).</b>"
))
story.append(p(
    "With support from <b>USAID (MCHIP)</b>, UNICEF, UNFPA, NIPF and other development partners, "
    "the Government of India introduced and supported RMNCH+A implementation. The approach "
    "is built on a strong platform: <b>9.15 lakh ASHA workers</b> and the three-tiered health system."
))
story.append(SP(6))

# ── SECTION 2 ──────────────────────────────────────────────────────
story += [h1("2. RMNCH+A - DEFINITION AND THE 'PLUS' FOCUS"), HR()]
story.append(p(
    "The RMNCH+A strategy is based on <b>provision of comprehensive care through five thematic "
    "pillars</b>: Reproductive, Maternal, Neonatal, Child, and Adolescent Health. It is guided by "
    "the central tenets of <b>equity, universal care, entitlement, and accountability.</b>"
))
story.append(h3("The '+' within the strategy focuses on:"))
for item in [
    "Including <b>adolescence for the first time as a distinct life stage</b>",
    "Linking maternal and child health to <b>reproductive health, family planning, adolescent "
     "health, HIV, gender, preconception and prenatal diagnostic techniques</b>",
    "Linking <b>home and community-based services to facility-based care</b>",
    "Ensuring linkages, referrals and counter-referrals between PHC (primary), CHC (secondary) "
     "and District Hospital (tertiary)",
]:
    story.append(b(item))
story.append(SP(4))
story.append(p(
    "The aim is to reach the maximum number of people in the remotest corners of the country "
    "through a <b>continuum of services</b>, constant innovation, and routine monitoring. Emphasis "
    "is on <b>high-impact interventions</b> in each of the five thematic areas, with a focus on "
    "<b>184 high-priority districts (HPDs) across India.</b>"
))
story.append(SP(6))

# ── SECTION 3 ──────────────────────────────────────────────────────
story += [h1("3. KEY COMPONENTS OF RMNCH+A STRATEGY"), HR()]

story.append(h2("3.1 High-Priority Districts (HPDs)"))
story.append(p(
    "Districts with relatively weak performance against RMNCH+A indicators were identified using "
    "uniform, clearly defined criteria: <b>184 HPDs across all 29 states.</b> The RMNCH+A 5x5 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 required."
))

story.append(h2("3.2 The RMNCH+A 5x5 Matrix"))
story.append(p("The <b>5x5 matrix</b> is the cornerstone of RMNCH+A planning. It identifies:"))
for item in [
    "<b>5 high-impact interventions</b> across each of the 5 thematic areas",
    "<b>5 cross-cutting</b> health systems strengthening interventions",
    "<b>Minimum essential commodities</b> required for implementation",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h2("3.3 Goals and Targets of RMNCH+A"))
story.append(make_table([
    ["Indicator", "Target"],
    ["Maternal Mortality Ratio (MMR)", "Reduce to 100 per 100,000 live births"],
    ["Infant Mortality Rate (IMR)", "Reduce to 25 per 1,000 live births"],
    ["Total Fertility Rate (TFR)", "Reduce to 2.1"],
    ["Stunting (children under 5)", "Reduce to 25%"],
    ["Child mortality - global pledge", "20 per 1,000 live births by 2035"],
], [W*0.55, W*0.45]))
story.append(SP(6))

story.append(h2("3.4 Implementation Strategies"))
for item in [
    "<b>Equity approach:</b> Focus on 184 HPDs with weakest RMNCH+A indicators",
    "<b>Continuum of care:</b> Pre-conception through adolescence, home to facility",
    "<b>High-impact interventions:</b> Targeting the 5x5 matrix at high coverage and high quality",
    "<b>ASHA platform:</b> 9.15 lakh ASHAs for community delivery",
    "<b>Convergence:</b> Reproductive health, family planning, child health, adolescent health, HIV, nutrition",
    "<b>Accountability:</b> Mother and Child Tracking System (MCTS) and routine data systems",
    "<b>Quality assurance:</b> LaQshya, PMSMA, facility-strengthening",
]:
    story.append(b(item))
story.append(SP(6))

# ── SECTION 4 ──────────────────────────────────────────────────────
story += [h1("4. KEY INTERVENTIONS - CONTINUUM OF CARE"), HR()]

story.append(h2("A. Reproductive Health"))
for item in [
    "Family planning counselling and provision of contraceptive services",
    "Spacing methods: IUCD 375/380A, Oral Contraceptive Pills, condoms, Centchroman, injectable contraceptives",
    "Limiting methods: female sterilization (Minilap/laparoscopy), vasectomy (NSV)",
    "Management of RTI and STI",
    "Prevention of unsafe abortion; safe abortion services under MTP Act",
    "Preconception care and genetic counselling",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h2("B. Maternal Health"))
for item in [
    "Early pregnancy registration (within 12 weeks) and at least <b>4 Antenatal Care (ANC) visits</b>",
    "<b>Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):</b> Fixed day (9th of every month) quality ANC at health facilities",
    "<b>Janani Suraksha Yojana (JSY) 2005:</b> Conditional cash transfer for institutional delivery; implemented in all states/UTs",
    "<b>Janani Shishu Suraksha Karyakram (JSSK) 2011:</b> Zero out-of-pocket expenditure; free healthcare and referral transport; extended to sick children up to age 1",
    "Skilled Birth Attendance (SBA) and Emergency Obstetric Care (EmOC)",
    "First Referral Units (FRUs) operational 24x7",
    "Prevention and management of anaemia - IFA supplementation",
    "Postnatal Care (PNC) - minimum 3 visits",
    "<b>SUMAN (Surakshit Matritva Aashwasan) scheme</b>",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h2("C. Newborn Health"))
for item in [
    "<b>Navjat Shishu Suraksha Karyakram (NSSK) (2009):</b> Basic newborn care and resuscitation training - 1.3 lakh providers trained",
    "<b>Facility Based Newborn Care (FBNC) (2011):</b> Three-tier facility care:",
    "  - <b>NBCC</b> (Newborn Care Corner): 14,135 established at delivery points - immediate essential care",
    "  - <b>NBSU</b> (Newborn Stabilization Unit): 1,810 at CHCs/FRUs - stabilize before referral",
    "  - <b>SNCU</b> (Special Newborn Care Unit): 548 at district/sub-district hospitals - all care except assisted ventilation and major surgery",
    "<b>Home Based Newborn Care (HBNC) (2011):</b> ASHA visits all newborns; special care of preterm/LBW; early detection and referral; 12+ lakh newborns visited in 2013",
    "Kangaroo Mother Care (KMC) for preterm and low birth weight babies",
    "Management of birth asphyxia, neonatal sepsis, hypothermia",
    "Early breastfeeding initiation within 1 hour; Exclusive Breastfeeding (EBF) for 6 months",
    "Vitamin K (1 mg IM) at birth; promotion of colostrum feeding",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h2("D. Child Health"))
for item in [
    "<b>Universal Immunization Programme (UIP):</b> Full immunization of all children",
    "<b>IMNCI (2007):</b> Integrated Management of Neonatal and Childhood Illnesses - operationalised in 500+ districts; 5.9 lakh health functionaries (physicians, nurses, AWWs, ASHAs) trained",
    "<b>F-IMNCI:</b> 26,800 medical officers and specialists at CHCs/FRUs trained",
    "<b>Rashtriya Bal Swasthya Karyakram (RBSK) (2013):</b> Screening of children for 4 Ds - Defects at birth, Diseases, Deficiencies, Developmental delays",
    "Management of Severe Acute Malnutrition (SAM) at Nutrition Rehabilitation Centres (NRCs)",
    "Vitamin A supplementation",
    "ORT and Zinc for diarrhoea management; Cotrimoxazole for pneumonia at community level",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h2("E. Adolescent Health"))
for item in [
    "<b>Rashtriya Kishor Swasthya Karyakram (RKSK) (2014):</b> National adolescent health programme",
    "Adolescent Friendly Health Clinics (AFHCs) - Aarogya Kendras",
    "<b>Weekly Iron and Folic Acid Supplementation (WIFS):</b> For 10-19 years (boys and girls) - 100 mg iron + 0.5 mg FA weekly - rolled out in 32 states/UTs - ~3 crore beneficiaries by December 2013",
    "<b>National Iron Plus Initiative (2013):</b> IFA supplementation across all life stages",
    "Menstrual hygiene management",
    "Prevention of early marriage and early pregnancy",
    "Life skills education and mental health; prevention of substance abuse",
    "Peer education programmes",
]:
    story.append(b(item))
story.append(SP(6))
story.append(PageBreak())

# ── SECTION 5 ──────────────────────────────────────────────────────
story += [h1("5. TABLE 16 - NHM INTERVENTIONS FOCUSING ON NEWBORNS (Park's)"), HR()]

story.append(make_table([
    ["Programme (Year)", "Objectives", "Status / Key Facts"],
    ["Janani Suraksha Yojana (JSY) (2005)",
     "Safe motherhood; increase institutional delivery through demand-side financing and conditional cash transfer",
     "All states and UTs; special focus on low-performing states"],
    ["IMNCI and F-IMNCI (2007)",
     "Standard case management of neonatal and childhood morbidity and mortality",
     "500+ districts; 5.9 lakh health functionaries trained; 26,800 MOs at CHCs/FRUs trained under F-IMNCI"],
    ["Navjat Shishu Suraksha Karyakram (NSSK) (2009)",
     "Basic newborn care and resuscitation training programme",
     "1.3 lakh health providers trained to date"],
    ["Janani Shishu Suraksha Karyakram (JSSK) (2011)",
     "Zero out-of-pocket expenditure for maternal and infant health through free healthcare and referral transport entitlements",
     "All states and UTs; assured service package extended to sick children up to age 1"],
    ["Facility Based Newborn Care (FBNC) (2011)",
     "NBCCs at delivery points; NBSUs at CHC/FRUs; SNCUs at district/sub-district hospitals",
     "14,135 NBCCs; 1,810 NBSUs; 548 SNCUs; 6,300+ personnel trained; online reporting in 7 states"],
    ["Home Based Newborn Care (HBNC) (2011)",
     "Essential newborn care by ASHA; special care of preterm/LBW; early detection and referral; adoption of healthy practices",
     "All states/UTs; 12+ lakh newborns visited in 2013"],
    ["Rashtriya Bal Swasthya Karyakram (RBSK) (2013)",
     "Screening children for birth defects, diseases, deficiencies and developmental delays (4 Ds)",
     "Mobile health teams at schools and AWCs; districtlevel Early Intervention Centres (EICs)"],
], [W*0.26, W*0.39, W*0.35], small=True))
story.append(SP(8))

# ── SECTION 6 ──────────────────────────────────────────────────────
story += [h1("6. INDIA NEWBORN ACTION PLAN (INAP), 2014"), HR()]

story.append(p(
    "In the past two decades, there has been remarkable progress in the survival of mothers and "
    "children beyond the newborn period. Two important milestones: the <b>National Rural Health "
    "Mission (NRHM)</b> and the <b>RMNCH+A Strategy (2013).</b> By adopting RMNCH+A strategy in 2013, "
    "the country observed a <b>paradigm shift</b> in its approach towards health care. "
    "<b>Newborn health occupies centre stage</b> in the overall strategy."
))
story.append(p(
    "The <b>India Newborn Action Plan (INAP)</b>, developed in response to the global <b>Every Newborn "
    "Action Plan (ENAP)</b>, was <b>launched in June 2014.</b> INAP will be implemented within the "
    "existing RMNCH+A framework."
))

story.append(h3("Goals of INAP:"))
for item in [
    "<b>Single Digit Neonatal Mortality Rate (NMR) by 2030</b>",
    "<b>Single Digit Stillbirth Rate (SBR) by 2030</b>",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h3("Guiding Principles of INAP (7):"))
for item in ["Integration", "Equity", "Gender", "Quality of care",
             "Convergence", "Accountability", "Partnerships"]:
    story.append(b(item))
story.append(SP(4))

story.append(h3("Six Pillars (Intervention Packages) of INAP:"))
for i, item in enumerate([
    "Pre-conception and antenatal care",
    "Care during labour and childbirth",
    "Immediate newborn care",
    "Care of the healthy newborn",
    "Care of small and sick newborn",
    "Care beyond newborn survival",
], 1):
    story.append(b(f"<b>Pillar {i}:</b> {item}"))
story.append(SP(4))

story.append(h3("Categorization of Interventions:"))
for item in [
    "<b>Essential [E]</b> - to be implemented universally",
    "<b>Situational [S]</b> - implementation dependent on epidemiological context",
    "<b>Advanced [A]</b> - implementation based on health-system capacity of the state/district",
]:
    story.append(b(item))
story.append(SP(4))
story.append(p(
    "It is estimated that high coverage of these packages can prevent almost "
    "<b>three-quarters of newborn deaths, one-third of stillbirths, and half of maternal "
    "deaths by 2025.</b>"
))
story.append(SP(6))

# ── SECTION 7 ──────────────────────────────────────────────────────
story += [h1("7. INAP PILLAR 1 - PRE-CONCEPTION AND ANTENATAL CARE"), HR()]

story.append(p(
    "Health interventions must start well <b>before conception</b> and their impact on the "
    "neonatal and stillbirth outcome requires equivalent consideration. Key interventions:"
))
for item in [
    "Periconceptional folic acid supplementation (0.4 mg/day) to prevent neural tube defects",
    "Screening and treatment of infections: syphilis, HIV, hepatitis B, TB, malaria",
    "Tetanus toxoid immunization",
    "IFA supplementation during pregnancy (100 mg elemental iron + 0.5 mg FA daily)",
    "Detection and management of hypertensive disorders (pre-eclampsia/eclampsia)",
    "Screening for gestational diabetes",
    "Detection and management of anaemia (Hb &lt; 11 g/dL)",
    "Thyroid screening",
    "Calcium supplementation (1 g/day) from 20 weeks gestation",
    "Counselling on birth preparedness and complication readiness",
    "Prevention and treatment of malaria in endemic areas",
    "Anti-D immunoglobulin for Rh-negative mothers",
]:
    story.append(b(item))
story.append(SP(6))
story.append(PageBreak())

# ── SECTION 8 ──────────────────────────────────────────────────────
story += [h1("8. RMNCH+A AS NEW INITIATIVE UNDER NRHM"), HR()]

story.append(p(
    "A <b>continuum of care approach</b> has now been adopted under NRHM with the articulation "
    "of the strategic approach to RMNCH+A in India. This approach:"
))
for item in [
    "Brings focus on <b>adolescents as a critical life stage</b>",
    "Creates linkages between child survival, maternal health and family planning",
    "Strengthens referral linkages between <b>community and facility-based health services</b>",
    "Links the various levels of the health system",
]:
    story.append(b(item))
story.append(SP(4))

story.append(h3("Delivery Points (DPs):"))
story.append(p(
    "Health facilities with high demand for services and performance above a benchmark have "
    "been identified as <b>Delivery Points</b> for providing comprehensive RMNCH+A services. "
    "<b>~25,000 health facilities</b> identified as Delivery Points for focused support under NRHM. "
    "Funds allocated for infrastructure, human resource, drugs, and equipment."
))

story.append(h3("Mother and Child Health (MCH) Wings:"))
story.append(p(
    "100/50/30-bedded <b>MCH Wings</b> sanctioned in public health facilities with high bed "
    "occupancy. <b>More than 32,000 additional beds</b> sanctioned across 550 health facilities "
    "across 18 states."
))

story.append(h3("National Iron Plus Initiative (2013):"))
story.append(p(
    "Launched in 2013 to prevent and control iron deficiency anaemia. Provides IFA "
    "supplementation for children, adolescents, and women in reproductive age group (in "
    "addition to pregnant and lactating mothers). <b>WIFS (Weekly Iron and Folic Acid "
    "Supplementation)</b> for 10-19 years has been rolled out in <b>32 states and UTs</b>, "
    "covering <b>~3 crore beneficiaries</b> by December 2013."
))
story.append(SP(6))

# ── SECTION 9 ──────────────────────────────────────────────────────
story += [h1("9. RMNCH+A STRATEGY AND SCHEDULED TRIBE (ST) HEALTH"), HR()]

story.append(p(
    "RMNCH+A has special relevance for ST populations given their disproportionate health burden:"
))
story.append(make_table([
    ["Health Indicator", "ST Population", "National Average"],
    ["Life expectancy at birth", "63.9 years", "67 years"],
    ["Institutional delivery rate", "68.0%", "78.9%"],
    ["Skilled birth attendance", "71.5%", "-"],
    ["PNC within 48 hrs (home delivery)", "37%", "-"],
    ["IMR (NFHS-4)", "44.4 per 1,000 LB", "Lower"],
    ["1-4 year child mortality rate", "13.4", "Lower"],
    ["Under-5 Mortality Rate (U5MR)", "57.2 per 1,000 LB", "Lower"],
    ["Neonatal Mortality Rate (NMR)", "31.3 per 1,000 LB", "Lower"],
], [W*0.45, W*0.27, W*0.28]))
story.append(SP(4))
story.append(p(
    "<b>Risk factors for high maternal mortality in tribals:</b> early marriage, early childbirth, "
    "low BMI, and high incidence of anaemia. Immunization coverage and nutritional status "
    "(stunting, wasting, underweight) of tribal children remain lower than national averages "
    "despite improvement in time trend."
))
story.append(SP(6))

# ── SECTION 10 ──────────────────────────────────────────────────────
story += [PageBreak(), h1("10. RMNCHA+N - EXTENSION WITH NUTRITION"), HR()]

story.append(p(
    "The RMNCH+A strategy has been progressively expanded to incorporate <b>Nutrition (N)</b> "
    "as an integral component, forming <b>RMNCHA+N</b>. This reflects the recognition that "
    "nutrition underpins outcomes across all life stages covered by the strategy."
))

story.append(h2("10.1 Rationale for Adding Nutrition"))
for item in [
    "~38% of children under 5 are stunted (low height for age)",
    "~21% are wasted (low weight for height)",
    "~36% are underweight",
    "~50% of pregnant women are anaemic",
    "Iron deficiency anaemia affects adolescent girls, pregnant women and lactating mothers",
    "Low birth weight (LBW) babies: ~18% of births in India",
    "Malnutrition contributes to ~45% of all child deaths",
]:
    story.append(b(item))
story.append(SP(6))

story.append(h2("10.2 Nutrition Interventions Integrated by Life Stage"))

story.append(h3("Pre-conception and Reproductive Phase:"))
for item in [
    "Periconceptional folic acid (0.4 mg/day)",
    "Correction of anaemia before pregnancy",
    "Nutritional counselling for women in reproductive age group",
]:
    story.append(b(item))
story.append(SP(3))

story.append(h3("Maternal Phase:"))
for item in [
    "IFA (100 mg elemental iron + 0.5 mg folic acid daily) throughout pregnancy",
    "Calcium supplementation (1 g/day) from 20 weeks",
    "Iodine supplementation where endemic",
    "Dietary counselling and diversification",
    "Early detection and management of severe anaemia (Hb &lt; 7 g/dL)",
]:
    story.append(b(item))
story.append(SP(3))

story.append(h3("Newborn Phase:"))
for item in [
    "Early initiation of breastfeeding within 1 hour of birth",
    "Exclusive breastfeeding (EBF) for 6 months - no water, no prelacteal feeds",
    "Vitamin K (1 mg IM) at birth",
    "Promotion of colostrum feeding",
]:
    story.append(b(item))
story.append(SP(3))

story.append(h3("Child Phase (0-5 years):"))
for item in [
    "Complementary feeding from 6 months alongside continued breastfeeding",
    "Vitamin A supplementation: 1 lakh IU at 6 months; 2 lakh IU every 6 months thereafter up to 5 years",
    "IFA supplementation (20 mg/day) for children 6 months to 5 years",
    "Zinc supplementation in diarrhoea (20 mg/day for 14 days in children &gt;6 months)",
    "Management of SAM at Nutrition Rehabilitation Centres (NRCs)",
    "National Deworming Day (NDD): Albendazole 400 mg biannually (2nd Wednesday of Feb and Aug)",
]:
    story.append(b(item))
story.append(SP(3))

story.append(h3("Adolescent Phase (10-19 years):"))
for item in [
    "<b>WIFS:</b> Weekly IFA (100 mg iron + 0.5 mg FA) for boys and girls",
    "Biannual deworming with Albendazole 400 mg",
    "Nutrition counselling - balanced diet, prevention of anaemia",
    "Promotion of iodized salt consumption",
    "BMI monitoring and referral",
]:
    story.append(b(item))
story.append(SP(6))

story.append(h2("10.3 Key National Nutrition Programmes under RMNCHA+N"))
story.append(make_table([
    ["Programme", "Target Group", "Key Component"],
    ["ICDS (Integrated Child Development Services)",
     "0-6 yrs; pregnant and lactating women",
     "Supplementary nutrition, immunization, health check-up, referral, pre-school education"],
    ["National Iron Plus Initiative (NIPI) (2013)",
     "6 months-5 yrs; adolescents 10-19 yrs; women 15-49 yrs",
     "IFA supplementation across life stages; WIFS for adolescents"],
    ["National Deworming Day (NDD)",
     "1-19 years",
     "Biannual Albendazole 400 mg; 2nd Wednesday of Feb and Aug"],
    ["Pradhan Mantri Matru Vandana Yojana (PMMVY)",
     "Pregnant and lactating women - first live birth",
     "Rs 5,000 cash incentive in 3 instalments for nutrition and wage compensation"],
    ["Poshan Abhiyaan (National Nutrition Mission) (2018)",
     "Children 0-6 yrs; adolescents; pregnant and lactating women",
     "Reduce stunting 2%/yr; wasting 2%/yr; anaemia 3%/yr; LBW 2%/yr"],
    ["PM-POSHAN (Mid-Day Meal)",
     "School children Class 1-8",
     "Hot cooked meal with caloric and protein standards"],
], [W*0.30, W*0.27, W*0.43], small=True))
story.append(SP(8))

# ── SECTION 11 ──────────────────────────────────────────────────────
story += [h1("11. RMNCH+A / RMNCHA+N AND SDG LINKAGE"), HR()]

story.append(p(
    "RMNCH+A / RMNCHA+N strategy is directly aligned with <b>SDG Goal 3 (Good Health and "
    "Well-Being)</b> and <b>SDG Goal 2 (Zero Hunger):</b>"
))
for item in [
    "<b>SDG 3.1:</b> Reduce global MMR to &lt;70 per 100,000 live births by 2030",
    "<b>SDG 3.2:</b> End preventable deaths of newborns and under-5 children; NMR to 12 or fewer per 1,000 LB; U5MR to 25 or fewer per 1,000 LB by 2030",
    "<b>SDG 3.7:</b> Universal access to sexual and reproductive health services including family planning",
    "<b>SDG 3.8:</b> Achieve Universal Health Coverage (UHC)",
    "<b>SDG 2.2:</b> End all forms of malnutrition by 2030 (directly links to RMNCHA+N component)",
]:
    story.append(b(item))
story.append(SP(4))
story.append(note(
    "Park's notes: The RMNCH abbreviation in the SDG monitoring framework stands for "
    "Reproductive, Maternal, Newborn and Child Health (RMNCH) as part of UHC target 3.8."
))
story.append(SP(6))

# ── SECTION 12 ──────────────────────────────────────────────────────
story += [PageBreak(), h1("12. HIGH-YIELD EXAM SUMMARY (Quick Revision)"), HR()]

story.append(make_table([
    ["Topic", "Key Fact / Figure"],
    ["RMNCH+A launch", "February 2013, India Child Survival Summit"],
    ["Global Call to Action Summit", "June 2012, Washington DC (India, Ethiopia, USA, UNICEF)"],
    ["Child mortality pledge", "20 or fewer per 1,000 live births by 2035"],
    ["ASHA workers platform", "9.15 lakh ASHAs"],
    ["High-Priority Districts", "184 HPDs across 29 states"],
    ["Five thematic areas", "Reproductive - Maternal - Newborn - Child - Adolescent"],
    ["5x5 matrix", "5 interventions x 5 thematic areas + cross-cutting interventions"],
    ["MMR target", "100 per 100,000 live births"],
    ["IMR target", "25 per 1,000 live births"],
    ["TFR target", "2.1"],
    ["Delivery Points", "~25,000 health facilities"],
    ["MCH Wings (beds)", "32,000+ additional beds across 550 facilities, 18 states"],
    ["INAP launch", "June 2014; in response to global ENAP"],
    ["INAP goals", "Single digit NMR by 2030; Single digit SBR by 2030"],
    ["INAP pillars", "6 pillars (pre-conception to care beyond survival)"],
    ["INAP categories", "Essential (E), Situational (S), Advanced (A)"],
    ["FBNC levels", "NBCC (delivery point) - NBSU (CHC/FRU) - SNCU (district hospital)"],
    ["NBCCs established", "14,135"],
    ["NBSUs established", "1,810"],
    ["SNCUs established", "548"],
    ["NSSK (2009)", "Basic newborn care and resuscitation; 1.3 lakh providers trained"],
    ["HBNC (2011)", "ASHA visits newborns; 12+ lakh visited in 2013"],
    ["RBSK (2013)", "4 Ds: Defects, Diseases, Deficiencies, Developmental delays"],
    ["WIFS", "10-19 yrs; 100 mg iron + 0.5 mg FA weekly; 32 states/UTs; ~3 crore beneficiaries"],
    ["National Iron Plus Initiative", "2013; IFA across life stages from 6 months to 49 years"],
    ["INAP impact estimate", "75% NB deaths, 33% stillbirths, 50% maternal deaths prevented by 2025"],
    ["ST (tribal) IMR", "44.4 per 1,000 LB (NFHS-4)"],
    ["ST institutional delivery", "68.0% vs national 78.9%"],
    ["SDG alignment", "SDG 3.1, 3.2, 3.7, 3.8 (health); SDG 2.2 (nutrition)"],
], [W*0.38, W*0.62]))
story.append(SP(8))

# ── SECTION 13 ──────────────────────────────────────────────────────
story += [h1("13. MNEMONICS AND MEMORY AIDS"), HR()]

story.append(h3("RMNCH+A - Five Thematic Areas:"))
for item in [
    "<b>R</b> - Reproductive Health",
    "<b>M</b> - Maternal Health",
    "<b>N</b> - Newborn Health",
    "<b>C</b> - Child Health",
    "<b>A</b> - Adolescent Health",
    "<b>+</b> - The PLUS: links all five into a Continuum of Care",
]:
    story.append(b(item))
story.append(SP(6))

story.append(h3("INAP Six Pillars (in order):"))
for i, item in enumerate([
    "Pre-conception and ANC",
    "Care during labour and childbirth",
    "Immediate newborn care",
    "Care of healthy newborn",
    "Care of small and sick newborn",
    "Care beyond newborn survival",
], 1):
    story.append(b(f"<b>{i}.</b> {item}"))
story.append(SP(6))

story.append(h3("RBSK - 4 Ds:"))
for item in [
    "<b>D</b>efects at birth",
    "<b>D</b>iseases",
    "<b>D</b>eficiencies",
    "<b>D</b>evelopmental delays and disabilities",
]:
    story.append(b(item))
story.append(SP(6))

story.append(h3("FBNC Three Levels (ascending):"))
for item in [
    "<b>NBCC</b> (Newborn Care Corner) - at all delivery points - immediate essential newborn care",
    "<b>NBSU</b> (Newborn Stabilization Unit) - at CHC/FRU - stabilize selected conditions before referral",
    "<b>SNCU</b> (Special Newborn Care Unit) - at district/sub-district hospital - all care except ventilation and major surgery",
]:
    story.append(b(item))
story.append(SP(6))

story.append(h3("WIFS Dose (easy recall):"))
story.append(p(
    "<b>W</b>eekly - <b>I</b>FA - <b>F</b>or - <b>S</b>chool age (10-19 yrs): "
    "100 mg elemental iron + 0.5 mg folic acid, once weekly"
))
story.append(SP(8))

# ── FOOTER ──────────────────────────────────────────────────────────
story.append(HR())
story.append(note(
    "Source: Park's Textbook of Preventive and Social Medicine, 26th Edition. "
    "Content strictly follows Park's chapter structure and wording (Chapters on "
    "National Health Programmes - Blocks 6, 7, 8, 10). "
    "For university examination use only. All statistics as per the edition consulted."
))

doc.build(story)
print("PDF generated:", OUTPUT)