RMNCAH+Na) Objectives b) Components c) Interventions 10 marks
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RMNCAH+N objectives components interventions India NHM
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Here is a complete, exam-ready answer on RMNCAH+N covering all three parts for 10 marks:
RMNCAH+N - Reproductive, Maternal, Newborn, Child, Adolescent Health + Nutrition
Background
Following the Government of India's "Call to Action (CAT) Summit" in February 2013, the Ministry of Health and Family Welfare launched RMNCAH+N under the National Health Mission (NHM). It is an extension and update of the earlier RMNCH+A strategy and is aligned with SDG Goal 3 (ensuring healthy lives for all ages). The strategy is built on the continuum of care concept - a lifecycle approach that links interventions from preconception through adolescence.
The "+" (PLUS) in the strategy denotes:
- Inclusion of adolescence as a distinct life stage
- Linking maternal and child health to reproductive health, family planning, HIV, gender, and prenatal diagnostic techniques
- Linking home/community-based services to facility-based services
- Ensuring linkages, referrals, and counter-referrals between all levels of the health care system
a) Objectives
- Reduce Maternal Mortality Ratio (MMR) - Target: below 100/1,00,000 live births (NHP target); below 70 by 2030 (SDG). Current status: 88 (SRS 2020-22).
- Reduce Neonatal Mortality Rate (NMR) - Target: ≤16/1,000 live births by 2025; ≤12 by SDG 2030.
- Reduce Infant Mortality Rate (IMR) - Target: 28/1,000 live births; current: 28 (SRS 2020).
- Reduce Under-5 Mortality Rate (U5MR) - Target: ≤23 by 2025; ≤25 by SDG 2030; current: 32.
- Achieve Replacement Level Fertility - Total Fertility Rate (TFR) target: 2.1; current: 2.0.
- Improve nutritional status of women and children:
- 50% reduction in stunting in under-5 children by 2030
- 50% reduction in anaemia in women of reproductive age
- 30% reduction in low birth weight
- Maintain childhood overweight below 3%
- Increase exclusive breastfeeding rates
- Increase institutional delivery - Target: 100% births in accredited facilities
- Universal antenatal care (ANC) coverage
- Increase facilities equipped for perinatal care by 100%
- Promote evidence-based, high-impact interventions at every stage of the lifecycle
Three strategic objectives (process-level):
- Resource availability - infrastructure, human resources, capacity, fund availability
- Health systems capacity at district and state levels - supply chain, supervision, data, fund utilization
- BCC/IEC strategies at block level - ensuring timeliness, continuity, and quality of essential interventions
b) Components
The RMNCAH+N framework has six major thematic components across the lifecycle:
| # | Component | Life Stage | Focus |
|---|---|---|---|
| 1 | Reproductive Health (RH) | Adolescents & Adults | Family planning, contraception, RTI/STI management, preconception care, PCPNDT compliance |
| 2 | Maternal Health (MH) | Pregnancy & Delivery | ANC, skilled birth attendance, institutional delivery, emergency obstetric care, postnatal care |
| 3 | Newborn Health (NH) | Birth to 28 days | Essential newborn care, resuscitation, Kangaroo Mother Care (KMC), care of sick newborns |
| 4 | Child Health (CH) | 0-5 years | Immunization, IMNCI, management of diarrhoea, pneumonia, malnutrition |
| 5 | Adolescent Health (AH) | 10-19 years | RKSK (Rashtriya Kishor Swasthya Karyakram), nutrition, ARSH clinics, menstrual hygiene |
| 6 | Nutrition (N) | All ages | POSHAN Abhiyaan, Anaemia Mukt Bharat, supplementary nutrition, IYCF promotion |
Cross-cutting components:
- Health Systems Strengthening (HSS) - infrastructure, HR, supply chain, referral transport
- Demand generation - ASHA, community mobilization, IEC/BCC
- Quality of care - LaQshya, NQAS certification, SBA training
- Accountability and monitoring - HMIS-based dashboard, Score Cards, High Priority Districts (HPD) approach
c) Key Interventions
1. Reproductive Health Interventions
- Provision of contraceptive services (spacing and limiting methods)
- Management of RTIs/STIs
- Pre-conception and prenatal diagnostic counseling
- Mission Parivar Vikas (for high TFR districts)
2. Maternal Health Interventions
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) - Free ANC on 9th of every month
- Minimum 4 ANC check-ups (now 8 per WHO recommendation)
- Iron-Folic Acid (IFA) supplementation
- Tetanus Toxoid (TT) immunization
- Janani Suraksha Yojana (JSY) - cash incentive for institutional delivery
- Janani Shishu Suraksha Karyakram (JSSK) - free services for pregnant women and sick newborns
- LaQshya - Quality improvement in labour rooms and maternity OTs
- Obstetric care at CEmONC and BEmONC facilities
- Skilled Birth Attendance (SBA) training
3. Newborn Health Interventions
- Home-Based Newborn Care (HBNC) by ASHA workers (7 home visits in 42 days)
- Home-Based Care of Young Child (HBYC) (extended to 15 months)
- Essential Newborn Care (ENC) - warmth, cord care, breastfeeding initiation within 1 hour
- Kangaroo Mother Care (KMC) for low birth weight babies
- Newborn resuscitation (Helping Babies Breathe protocol)
- Special Newborn Care Units (SNCUs) and Newborn Stabilisation Units (NBSUs) at facilities
- Newborn screening (birth defects, hypothyroidism)
4. Child Health Interventions
- Universal Immunization Programme (UIP) - Mission Indradhanush for full coverage
- Integrated Management of Neonatal and Childhood Illness (IMNCI)
- ORS and Zinc for diarrhoea management
- Management of Severe Acute Malnutrition (SAM) - Nutrition Rehabilitation Centres (NRCs)
- Vitamin A supplementation
- Rashtriya Bal Swasthya Karyakram (RBSK) - 4D screening (Defects, Deficiencies, Diseases, Developmental delays)
- Childhood blindness prevention
5. Adolescent Health Interventions
- RKSK (Rashtriya Kishor Swasthya Karyakram) - Peer educators, ARSH clinics, Saathiya platform
- Weekly IFA supplementation for adolescent girls and boys
- Menstrual Hygiene Scheme - subsidized sanitary napkins
- SABLA (Scheme for Adolescent Girls)
- Counseling on nutrition, sexual and reproductive health, mental health, substance abuse
6. Nutrition Interventions
- POSHAN Abhiyaan (National Nutrition Mission) - convergence across ministries
- Anaemia Mukt Bharat - IFA prophylaxis across all age groups (6 months - 49 years)
- MAA (Mothers' Absolute Affection) - promote breastfeeding, especially exclusive breastfeeding for 6 months
- Complementary feeding promotion
- Management of Moderate Acute Malnutrition (MAM) at Anganwadi Centres
- NRCs for SAM with medical complications
Key Features of the RMNCAH+N Strategy (Summary)
| Feature | Description |
|---|---|
| Lifecycle approach | Interventions from preconception to adolescence in a continuous chain |
| High Priority Districts (HPDs) | Geographic targeting of 184 districts with worst indicators |
| Score cards | HMIS-based dashboard monitoring for accountability |
| Community-facility linkage | ASHA as the pivot connecting homes to facilities |
| Convergence | Links NHM with ICDS, education, water, sanitation sectors |
| Equity focus | Special attention to tribal, urban poor, and marginalized populations |
Current Key Indicators (SRS 2020-22): MMR = 88, NMR = 20, IMR = 28, U5MR = 32, TFR = 2.0 - showing significant progress but gaps remaining toward SDG 2030 targets.
Sources: NHM - RMNCAH+N Official Page | Journal of Comprehensive Health - RMNCH+A Strategic Approach | Ministry of Health & Family Welfare, PIB Update 2024
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