NHM Maternal, Child & Adolescent Health Programs: A Comprehensive Overview

1. JSY - Janani Suraksha Yojana

• Reduce maternal and neonatal mortality by encouraging institutional deliveries
• Focus on below-poverty-line (BPL) families

Classification of States

Cash Assistance (from 2012-13)

Key Features

• LPS: Benefit extended to all women including SC/ST; up to 3rd child if mother opts for sterilization post-delivery
• HPS: Restricted to BPL women and SC/ST women; benefit limited to 2 live births
• ASHA's role: Link worker in LPS - escorts pregnant women to health centres, ensures antenatal and postnatal care, receives transport cash (minimum Rs. 250) and incentive (minimum Rs. 200) per delivery
• BPL home delivery: Rs. 500 cash assistance regardless of age/parity in both LPS and HPS
• Caesarean section subsidy: Up to Rs. 1500 to government institutions without a government specialist
• Direct Benefit Transfer: Payments via Aadhaar-linked bank accounts
• By 2018-19, approximately 100.41 lakh pregnant women benefited annually; since inception over 1681 lakh (168.1 million) total beneficiaries

2. JSSK - Janani Shishu Suraksha Karyakram

Entitlements for Pregnant Women

1. Free and zero-expense delivery including caesarean section
2. Free drugs and consumables
3. Free diet during hospital stay
4. Free diagnostics
5. Free blood transfusion
6. Free transport from home to facility (Dial 102)
7. Free inter-facility transfer in case of referral
8. Free drop-back home after delivery

Entitlements for Sick Newborns (up to 1 year of age)

• Free treatment, drugs, diagnostics, diet and transport for sick infants

3. RKSK - Rashtriya Kishor Swasthya Karyakram

Six Priority Areas

1. Nutrition - Reduce malnutrition, anaemia, overweight/obesity in adolescents
2. Sexual and Reproductive Health (SRH) - Improve knowledge and behaviour, reduce teenage pregnancy, meet unmet contraception needs, reduce STIs and HIV
3. Mental Health - Address mental health concerns of adolescents
4. Injuries and Violence - Prevent injuries and gender-based violence (GBV)
5. Substance Misuse - Increase awareness of adverse effects of substance abuse
6. Non-Communicable Diseases (NCDs) - Promote behaviour change to prevent diabetes, cardiovascular disease, cancer

Core Interventions

• Weekly Iron and Folic Acid Supplementation (WIFS): For adolescents aged 10-19 years; rolled out in 32+ states and UTs covering ~3 crore beneficiaries
• Adolescent Friendly Health Centres (AFHCs) at PHC, CHC, SDH and District Hospital levels with dedicated counsellors and ANMs
• Menstrual Hygiene Scheme: Low-cost sanitary napkins at Rs. 6 per pack through ASHAs
• Peer-educator model for community-level health promotion
• Parents and community involvement since adolescents often lack autonomy in decision-making

4. RBSK - Rashtriya Bal Swasthya Karyakram

Note: The acronym "RKSY" does not correspond to a standard NHM program. This likely refers to RBSK (Rashtriya Bal Swasthya Karyakram), launched February 2013.

1. Defects at birth (congenital conditions)
2. Diseases in children (covering 30 conditions across 4 Ds)
3. Deficiencies (nutritional deficiencies)
4. Developmental delays including disabilities

Implementation

• Mobile Health Teams (2 per block) at block PHC level - each team has a Medical Officer, staff nurse, pharmacist
• Biannual screening of pre-school children (0-6 years) via Anganwadis
• Annual screening for children 6-18 years in government and government-aided schools
• Referral to District Early Intervention Centres (DEICs) for management including surgical interventions at tertiary level - free of cost
• DEICs staffed with: Paediatrician, Medical Officer, Dentist, Physiotherapist, Audiologist, Speech Therapist, Psychologist, Optometrist, Lab Technician

5. Cold Chain (under Universal Immunization Programme)

Temperature Requirements

Cold Chain Equipment (Hierarchical)

• Walk-in-Freezer (WIF): Maintains -15°C to -25°C; pre-fabricated PUF-insulated; used for bulk OPV storage and ice pack preparation; has automatic standby generator and continuous temperature recorder/alarm
• Walk-in-Cooler (WIC): Maintains +2°C to +8°C; capacities of 16.5, 32, 40 cubic metres; stores all UIP vaccines in bulk; installed at government medical store depots, state/regional vaccine stores

• Deep Freezer (DF): Top-opening lid; cabinet temperature -15°C to -25°C; stores OPV for 3 months (district level and above) and freezes ice packs (sub-district level only); limited hold-over time

• Ice Lined Refrigerator (ILR): Maintains +2°C to +8°C; top-opening (retains cold air better than front-opening); lined with frozen water containers that maintain temperature for minimum 8 hours during power cuts; available in different sizes (larger for district HQ, smaller for PHC HQ)
• Vaccine Carriers: For transport to immunization sessions with ice packs

Cold Chain Principles

• Once vaccine potency is lost due to temperature exposure, it cannot be regained
• Freeze-dried vaccines lose potency rapidly after reconstitution
• Opened multi-dose vials without preservative must be kept at +2°C to +8°C or used within 4 hours

6. PMSMA - Pradhan Mantri Surakshit Matritva Abhiyan

Services Provided on the 9th of Every Month

• Physical examination (weight, blood pressure, abdominal examination)
• Investigations: haemoglobin, urine albumin/sugar, blood group, ultrasound
• Screening for and management of high-risk conditions (anaemia, hypertension, gestational diabetes)
• Counselling on danger signs, nutrition, birth preparedness, breastfeeding, complementary feeding, family planning
• IFA and calcium supplementation

Key Features

• No additional cost: Financed from existing JSSK budget under NHM
• Voluntary participation of private specialists/obstetricians encouraged ("PMSMA volunteers")
• Beneficiaries include all pregnant women, but with special focus on those who missed earlier ANCs
• Extended as ePMSMA to cover additional fixed days

7. MAA - Mothers' Absolute Affection Programme

Key Components

• Promotion of early initiation of breastfeeding within 1 hour of birth (Skin-to-skin contact, colostrum feeding)
• Exclusive breastfeeding for 6 months - no other food, water, or liquid
• Promotion through ASHA workers and healthcare providers at health facilities
• Community mobilization and BCC (Behaviour Change Communication) activities
• Outcome indicator tracked in HMIS: "Breastfeeding in one hour rate" (babies breastfed within 1 hour of delivery as % of institutional deliveries)

Rationale

8. RMNCH+A - Reproductive, Maternal, Newborn, Child and Adolescent Health

Strategic Framework

1. Reproductive health (family planning, contraception, adolescent SRH)
2. Maternal health (ANC, skilled birth attendance, EmONC, PNC)
3. Newborn health (ENBC, resuscitation, SNCU/NBSU, HBNC)
4. Child health (immunization, RBSK, IMNCI, nutrition)
5. Adolescent health (RKSK, WIFS, AFHS)

Key Features

• Brings adolescents as a critical life stage into the mainstream health programme
• Links child survival, maternal health and family planning efforts
• Strengthens referral linkages between community and facility levels
• Identifies Delivery Points (DPs) - ~25,000 health facilities with comprehensive RMNCH+A services, focused funding for infrastructure, HR, drugs and equipment
• Aligns with SDG-3 (Good Health and Well-being) targets

9. HMIS - Health Management Information System

Data Coverage (300+ service delivery indicators, 400+ infrastructure indicators)

• RMNCH+A services (ANC, institutional delivery, PNC, immunization)
• Family planning
• Vector-borne diseases, TB, morbidity/mortality
• OPD/IPD services and surgeries

• Human resources, equipment availability
• Cleanliness, building status
• Availability of medical/surgical/diagnostic services

Indicator Types Tracked

Key Journey of HMIS

• 2008: District-level consolidated monthly uploads initiated
• 2011-12: Facility-based reporting initiated
• 2016-17: Revamping initiated
• December 2020: HMIS 2.0 launched with enhanced data elements and improved interface
• Mother and Child Protection Card data is recorded in the antenatal register "as per the HMIS format"

Linkage with MCTS

How These Programs Connect: The NHM Architecture

RMNCH+A Framework (Continuum of Care)
│
├── Reproductive & Maternal Health
│   ├── JSY (cash transfer → institutional delivery)
│   ├── JSSK (zero-cost entitlements at public facilities)
│   └── PMSMA (quality ANC on fixed day)
│
├── Newborn & Child Health
│   ├── JSSK (sick newborn entitlements)
│   ├── MAA (breastfeeding promotion)
│   └── RBSK (screening 0-18 yrs; 4 Ds)
│
├── Adolescent Health
│   └── RKSK (10-19 yrs; 6 priority areas)
│
├── Immunization Infrastructure
│   └── Cold Chain (WIF → WIC → DF → ILR → Vaccine Carrier)
│
└── Monitoring & Accountability
    └── HMIS 2.0 (300+ indicators; facility to national level)

Note on RKSY: This acronym does not correspond to a standard NHM programme. If you meant RBSK (Rashtriya Bal Swasthya Karyakram), it has been covered above. If "RKSY" refers to a different scheme in your curriculum or state-level programme, please clarify and I will add detail accordingly.