RCH
Introduction
Umbrella programme
The RCH Programme is an umbrella programme to
provide need based, client centered
demand driven, high quality services the beneficiaries
with a view to enhancing the quality of reproductive life
of the population and enabling country to achieve the
population stabilization.
RCH I launched in 1997
ORIGIN OF THE PROGRAMME
The International Conference of
Population and Development (ICPD) at
Cairo in 1994 was the basis for the
launch of RCH programme in our country
in 1997.
VISION OF THE PROGRAMME
The vision is to bring about outcomes as
envisioned in the Millennium Development Goals
The National Population Policy 2000 (NPP 2000)
The Tenth Plan document,
The National Health Policy 2002
Vision 2020 India
Definition
People have the ability to reproduce and regulate fertility, women
are able to go through pregnancy and child birth safely ,the
outcome of the pregnancy is successful in terms maternal and
infant survival wellbeing ,and couples are able to have sexual
relations free of fear of pregnancy and of contracting disease
( GOVT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE)
Main focus of definition
Right of men and women to be informed
of and to have access:
Safe, effective, affordable, and acceptable
methods of fertility regulation
Appropriate health care services that will
enable women to go safely through
pregnancy and childbirth
Provide couples with the best chance of
having a healthy infant.
CONCEPT OF R.C.H
It is an integrated approach of service
provide health services to young women
and young children through family
welfare programmmes like
UIP,or.CSSM,ARI control,Emergency and
essential obstectric care ,MTP services
,RTI and STD control, Essential new born
care and Vitamin A prophylaxis
BUDGET AND FUNDING FOR RCH
Program receives funding support from World Bank, DFID
( Department for International Development ) , European
Commission, UNFPA, USAID and other bilateral donors.
BUDGET AND FUNDING FOR RCH
The first phase of the RCH program has been in operation
since 1997 and funding from the major funding agency,
that is the World Bank will come to a close in March 2003.
The RCH phase 11 which is being processed is based on
lessons learnt from RCH I while forming a part of the Tenth
plan.
LAUNCHING OF R.C.H PROGRAMMES
RCH - I was launched in 1997 as a part of
9th plan
RCH - II was launched in first April 2005
as a part of 10th five year plan
THE
MAINintegrates
HIGHLIGHTS
OF R.C.H
The
programme
all interventions
of fertility
regulation
maternal and child health reproductive health for men
and women
The services given are client oriented ,demand driven,
high quality and based on needs of community through
decentralized participatory planning and target free
approach
The programe envisages upgradation :
means the first referral units being set up
at sub district level provide at sub district
level to provide comprehensive obstetric
care and new born care.
Facilities of obstetric care ,MTP,and IUD
insertion in the P.H.C.level are improved.
Specialist facilities for STD and RTI are available
at all district hospitals and fair number of sub
district level hospitals
The programme aims at improving the out reach
of services primarily for the vulnerable group of
population who have been effectively left out of
planning process such as urban slums, tribal
:
R.C.H DIFFERENT APPROACH
Based on the crude birth rate and female
literacy rate
all the districts have been divided into the
following:
A Category(58 Districts)
B Category (184 Districts)
C Category(265 Districts)
INTERVENTIONS IN ALL DISTRICTS
C.S.S.M
Safe mother hood interventions
Implementation of Target Free Approach
High quality training at all levels
IEC Activities
R.C.H Package for urban slums and tribal
areas
District sub-projects under local capacity enhancement
RTI/STD Clinics at district hospital (Where not available)
Facility for safe abortions at PHCs by providing
equipment and contractual doctors
Adolescent health and reproductive hygiene
INTERVENTIONS IN SELECTED
STATES / DISTRICTS
Screening and treatment of RTI/STD at
sub divisional levels
Emergency obstetric care at selected
FRUs by providing drugs
Essential obstetric care by providing
drugs and PHN/Staff Nurse at PHCs
Additional ANM at sub centers in the weak
districts for ensuring MCH care
Improved delivery services and emergency care
by providing equipment kits ,IUD insertions and
ANM kits at sub centres
Facility of referral transport for pregnant women
during emergency to the nearest referral
centres
C.S.S.M(CHILD SURVIVAL AND SAFE
MOTHER HOOD)
Initiated in 1992
Got integrated into R.C.H in 1997
Services are specified in RCH Programme
1. Registration of pregnancies at the early
period
2. Providing minimum 3 ANC check ups
3.
4.
5.
6.
7.
100% coverage of TT to pregnant
women
Nutrition education and advice
Detection of risk pregnancies
Immediate and prompt referral of risk
cases
Immediate and prompt referral of risk
8.
9.
10.
Safe delivery by trained Dai,MPW in the
community
Advice on birth spacing
Provision of institutional deliveries
DELIVERY SERVICE at PHC
To promote and provide institutional
deliveries,24 hours delivery facility at
PHC and provision for additional
honorarium to attending staff at PHC
MEDICAL TERMINATION OF PREGNANCY(MTP)
MTP is a reproductive measure that
enables a woman to opt out unwanted
pregnancy in certain specified
circumstances with out endangering the
life ,through MTP Act 1971.the aim is to
reduce the maternal mortality and
morbidity from unsafe abortions.
Manpower training and provision of
CONTROL OF REPRODUCTIVE TRACT INFECTIONS AND
STDS
With the provision of NACO (NATIONAL AIDS
CONTROL ORGANIZATION) of the assistance
to set up clinics ,a link with AIDS control ,is
an ongoing programme.training of
manpower and supply of drugs
UNIVERSAL IMMUNIZATION PROGRAMME (UIP)
This was earlier a part of CSSM and is now under
the scheme of RCH ,since 1997 provide
immunization against 6 preventable diseases.
Supply of DPT,DT,OPV,Maesles ,BCG and cold
chain establishment, and additional items will be
provided.
ORT Therapy
ORS packets are supplied to the states along
with drug kits ,every year 300 packets in 2 lots
are supplied by the central government .Rational
use of the drug and nutritional care and
preventive ORT are motivated to reduce
mortality
ACUTE RESPIRATORY DISEASE CONTROL
The standard case management of ARI and
prevention of deaths due to pneumonia is now
an integral part of RCH programme. Peripheral
health workers are being trained to recognize
and treat pneumonia.,Cotrimoxazoloe is supplied
to the health workers
VITAMIN A PROPHYLAXIS
Five doses of the vitamin A to all children
below the age of three years ,is provided with
specific doses:
9 months 1 dose 1 lakh units
18 months -11 dose 2 lakh units
24months -111 dose 2 lakh units
30 months-1v dose 2 lakh units
36 months-v dose 2 lakh units
EMERGENCY OBSTETRIC CARE
Many deliveries are home deliveries and if they are
associated with complications ,maternal morbidity and
mortality rate goes up. Thousands of referral units are
identified under the programme,they are strengthened
with emergency obstetric kit, equipment kit and skilled
health professional ,involvement of NGO for
decentralizing activities is another novel idea under RCH
ESSENTIAL OBSTETRIC CARE
This refers to basic maternity service to all
pregnant women in the country this ensures
the following:
Registration of pregnancy at 16 week
3 ANC check ups by ANMs
Safe delivery
3 PNC Check ups
ESSENTIAL NEW BORN CARE
This component reduces the perinatal and neonatal
mortality in community and the services are the following:
Resuscitation of the new born with asphyxia
Prevention of Hypothermia
Prevention of infection
Exclusive breast feeding
Referral of sick New born
Care of low birth weight babies
PREVENTION AND CONTROL
OF ANAEMIA IN CHILDREN
Iron deficiency anemia is widely prevalent in India in
young children .The National Family health survey11 (1998-99) revealed that 74.3% children under the
age of three years and below are anaemic under this
programme of control and prevention of anemia
,tablets containing 20 mg of elemental iron and 0.1
m,g of folic acid are provided at sub centre level
INITIATIVES TAKEN AFTER
ADOPTION OF NATIONAL
POPULATION POLICY
Inorder to make the service specialties like
gynecologists and pediatricians available to
people in remote areas ,a scheme holding camps
have been initiated in 102 districts covering 17
states from January 2001.
During 2001-2002, 72 districts were added
to include all the states and UTs in the country.
R.C.H Out Reach Scheme
During 2001-2002 ,an R.C.H out reach
scheme was initiated to strengthen the
delivery of immunization and child
health services .,in remote and
comparatively weaker sections and
urban slums
Operationalization of district
newborn care
Sixty districts have been provided
equipments to up-date neonatal facilities
Home based neonatal care
The department of family welfare has
approved two proposal for introducing
home based neonatal care
.The objective is to evolve a national
programe for provision of neonatal care
at grass root level.
Border district cluster strategy(BDCS)
Under this initiative 49 districts spread over as selected for
providing focused interventions for reducing the infant
mortality and maternal mortality rates by at least 50%
over the next two to three years it is a UNICEF associated
activity
The activities are development and training of health and
nutrition teams, physical upgradation of PHC, supply of
drugs and equipments, support for mobility of staff,
development of local IEC, training of medical officers,
upgradation of 1st referral units and filling of vacant posts
INTRODUCTION OF HEPPATITIS
B VACCINATION PROJECT
A pilot project for introduction of
hepatitis B in the national immunization
programme has been approved by the
govt. under this scheme vaccine will be
administered to infants with primary
dose of DPT vaccine
TRAININGF OF DAIS
This scheme was initiated during 20012002 in 156 districts of 18 states.
The aim was to train at least one dai in
every village.
121017 dais have been trained under
this scheme
RCH PROBLEM
Malnutrition
Pregnant women, lactating mothers and
children are effected by malnutrition
result in LBW, anemia, toxemia, PPH,
Direct intervention like
supplementation, indirect intervention
like environmental sanitation
Infection
Fetal growth retardation, puerperal
sepsis, LBW are due to maternal
infections.
Toxoplasma and CMV are increasing in
women.
Diarrhoea,ARI, skin infections are seen
to a great extent . malaria and TB are
serious infection of child hood
Uncontrolled reproduction
Repeated child birth leads to anaemia, abortion,
LBW, and APH.
Need for small family norm to safe guard mother
and child.
High birth rate is associated with high IMR and
under five death rate
INDICATORS OF RCH CARE
MMR
FOETAL DEATH
STILL BIRTH RATE
PERINATAL MORTALITY RATE
NEONATAL MORTALITY RATE
POST NEONATAL MORTALITY RATE
INFANT MORTALITY RATE
UNDER FIVE MORTALITY RATE
SOCIAL WELFARE
PROGRAMME FOR RCH
Integrated child development
services:
ICDS scheme was intiated in 1975
It is an integrated package of :
Supplementary nutrition
Immunization
Health check up
Medical referral service
Nutrition education
Health education
Non informal education of 0-6 children
Supplementary nutrition
Immunization
Health check up
Medical referral service
Nutrition education
Health education
Non informal education of 0-6 children
ACHIEVEMENTS
OF
R.CH
R.C.H 11
The structure, strategy and functioning of the
RCH Programme has been reviewed on the eve
of launching of 10th plan in the light of the
landmark National Population Policy 2000.
The program would also pay more attention
on the 8 states lagging behind in population
stabilsation efforts viz. Bihar, Chattisgarh,
Jharkhand, Madhya Pradesh, Orissa, Rajasthan,
Uttar Pradesh & Uttaranchal
Underserved groups of adolescents, urban
slums dwelling, males etc.
R. C. H .11- OBJECTIVES
The immediate objective, as envisioned in the
NPP 2000, is to address unmet needs of
contraception, health care infrastructure . Health
personnel and provide integrated service delivery
for basic reproductive and child health care.
The medium term objective, as outlined in the
NPP 2000, is to bring the total fertility rate to the
replacement level by 2010 through coordinated
implementation of inter- sectoral linkages
Features of RCH
Target free approach based
on community needs
Participatory planning
Emphasis on quality of care
and client satisfaction
BUDGET FOR RCH 11
EC Supported SIP :
The European Commission (EC) supported
Health and Family Welfare Sector Investment
Programme, known as Sector Investment
Programme is being implemented as a part of the
overall RCH Programme
The programme size is 240 Million Euros. Out of
this only 228 million Euros are available to GOI;
the remaining funds are used by EC for
positioning technical assistance, organizing
Essential
Components of
RCH-II Programme
Initiative
for
vulnerabl
e group
Strengtheni
ng systems
and
partnership
Population
stabilizati
on
Adolescen
t health
RC
H
Newborn
& child
health
RTI &
STI
Matern
al
health
Gender
equity
Population Stabilization
Population Stabilization
LOW
FEMALE
AUTONO
MY
WEAK
MOTIVATI
ON
Unmet need for
family planning
PERCEIVED
HEALTH
RISKS
MORAL
OBJECTIO
N
Expanding contraceptive
choices
Contraceptive choice can be expanded
by:
1. Adding new methods to the existing
range
2. Increasing access to the services
providing the choice.
Strategies to expand contraceptive
choice
Expanding the range of FP services
Improving and integrating RCH services in
PHCs and sub-centers
Training of District Hospital/CHC/PHC staff
to offer an expanded choice of services
Forging linkages with the ICDS division of
women and child development department
Engaging the private sector to provide
quality family planning services
Stimulating demand for quality family
planning services by increasing
compensation and by using media
Involving Panchayati Raj Institutions,
Urban Local Bodies and NGOs
Maternal Health
Reducing MMR to less than 10 per
100,000 live births by the year 2010.
The maternal mortality rate in India is
301 per 100,000 live births
Various schemes under the
programme
Essential Obstetric Care
The complete package of essential
obstetric care includes antenatal care,
institutional/ safe delivery services &
postnatal care. It has been seen that a total
of three antenatal checkups to be
conducted where all components of
essential obstetric care can be provided.
Provision of 24 hrs Delivery Services
at PHC: Under RCH II all the CHCs and
50% of the proposed PHCs will be
providing round the clock delivery
services
Provision of Emergency Obstetric
and Neonatal Care at First Referral
Referral
Unit Services at both Community and
Institutional level
Setting of Blood Storage Centers at FRUs
Training of MBBS Doctors in Life Saving
Anesthetics Skills for Emergency Obstetric Care
Obstetric Management skills
Postnatal care for mother and new
born
To ensure postnatal care within 24hours
of delivery and subsequent home visits
on day 3 and 7 are the important
components for identification and
management of emergencies occurring
during post natal period
Skilled Attendance at
Birth
To manage and handle some common
obstetric emergencies at the time of
birth the staff has been trained to give
certain injections and perform certain
interventions in emergency to save life.
Provision of Emergency
Obstetric and Neonatal Care
at First Referral Unit (FRU):
There are three critical elements of a
facility being declared as FRU. They
are availability of surgical
interventions, newborn care and
blood storage facility on a 24 hr
basis.
Referral Services at both Community
and Institutional level
Establishing referral linkages between
the community and FRUs is an essential
component for utilization of services
particularly during emergencies
Setting of Blood Storage Centers at
FRUs:
Timely treatment of complications
associated with pregnancy is sometimes
hampered due to non-availability of
Blood Transfusion services at FRUs.
Training of MBBS Doctors in Life Saving
Anesthetics Skills for Emergency Obstetric
Care:
Obstetric Management skills
GOI has also introduced training of MBBS doctors in
obstetric management skills and has prepared a 16
weeks training programme in obstetric management
skills including cesarean section operation.
Safe Abortion Services/ Medical
Termination of Pregnancy (MTP):
Provision of 24x7 MTP services at PHCs, CHCs and FRUs
are being strengthened by training of medical
manpower in techniques of MTP by the states.
Community Level
Spread awareness regarding safe MTP in the
community and the availability of services
Enhance access to confidential counseling foe safe
MTP, train ANMs, AWWs and link workers/ ASHA and
AWWs while maintain confidentiality
Facility
Level
Provide quality Manual Vacuum Aspiration )
facilities at all CHCs and at least 50% of PHCs that
are being strengthened for 24 hrs deliveries
Provide comprehensive and high quality MTP
services at all FRUs
Encourage private and NGO sectors to establish
quality MTP services
Other interventions for improving
maternal health
National Nutritional Anemia Prophylaxis
Program
Under this programme all pregnant and lactating
women are provided with one tablet
(containing 100 mg of elemental iron and
0.5mg Folic acid) for 100 days. Those who
have severe anemia are provide with double
dose
Village Health and Nutrition Day
Organizing village health and nutrition
day at Anganwadi center at least once a
month to provide antenatal / postpartum
care for pregnant women, promote
institutional delivery and health
education apart from other services
Janani Suraksha Yojana
(JSY):
It is a safe motherhood intervention under NRHM
being implemented with the objective of reducing
maternal and neonatal mortality by promoting
institutional delivery among the poor pregnant
women. It was launched on 12 April 2005 and is
being implemented in all states and is a 100 %
centrally sponsored scheme. The main element in
the yojana is ASHA who will act as a link between
govt and the poor pregnant woman
VANDEMATHARAM SCHEME
This is a voluntary scheme wherein any obstetric
and Gynaec specialist ,maternity home, nursing
home, ladydoctor,can volunteer themselves for
providing safe mother hood services. the
enrolled doctors will display vandemataram logo
at their clinic, .iron and folic acid tablets ,oral
pills TT injections will be provided by the district
medical officers for free distribution
Safe Abortion Services
In India abortion is a major cause of
maternal mortality and morbidity and
accounts for nearly 8.9% maternal death
,majority of abortions take place outside
authorized health services or by un
authorized or un skilled persons
a)medical method of abortion
Termination pof early pregnancy with
two drugs_ mifepristone(RU486)followed by misoprostol .they are
considered safe under supervision, with
appropriate counseling.
b) Manual vacuum aspiration(MVA)
The department of family welfare has
introduced MVA technique in the family
welfare programme .It is a safe and
simple technique for termination of early
pregnancy ,makes it feasible to be used
in PHCs or comparitible facilities ,there
by access to safe abortion services
Reproductive Tract Infections (RTIs) and
Sexually Transmitted Diseases (STDs)
Strategies
The prevention, early detection and
effective management of common lower
reproductive tract infections
Convergence with National AIDS Control
Programme
Convergence with National AIDS Control
Programme
Blood
safety
Lab
services
Newborn and Child Health
Activities undertaken
Integrated Management of newborn and childhood
illnesses:
India is faced with an unparalleled challenge in the area of
child survival and health. The country contributes 2.4
million of the global burden of 10.8 million under-five child
deaths, which is the highest for any nation in the world.
Nearly 26 million infants are born each year, of whom 1.2
million die before completing the first four weeks of life
and 1.7 million die before reaching the first birthday
Home Based Newborn Care(HBNC)
The Govt of India has approved the implementation
of home based new born care where ASHAs will be
trained in identified aspects of new born care during
the second year training. The underlying principle of
effective care at birth is that wherever an infant is
born, home or facility, he/ she is provided clean care,
warmth, resuscitation, and exclusive breastfeeding.
Promotion of Breast Feeding and
Complementary Feeding:
Revival of the Baby Friendly Hospital
initiative (BFHI) has been approved and
implementation shall be initiated.
Control of Deaths due to Acute Respiratory
Infections: (ARI): Acute respiratory infections
(ARI) in children can involve the upper respiratory
tract (nose, throat) or the lower respiratory tract
(bronchi, lungs). The lower respiratory tract
infections (broadly termed as pneumonias) are a
major cause of deaths of infants and children in
India accounting for about 30% of under-five deaths
Control of Deaths due to Diarrhoeal Diseases
Diarrhoeal diseases account for 17 percent of
under five mortality in post neonatal period, and
3 percent of neonatal deaths. The Oral
Rehydration Therapy (ORT) program was started
in 1986-1987.The main objective of the program
was to prevent deaths due to dehydration
caused by diarrhoeal disease through ORS
Supplementation with
micronutrients: National Programme
for Prophylaxis against Blindness in
Children caused due to Vitamin A
deficiency is being implemented through
RCH programme. The objectives are to
decrease the prevalence of Vit A
deficiency to 0.3%.
Anemia among Children:
Iron deficiency anaemia is widely prevalent in
young children. NFHS II (1998-99) revealed that
74.3% children under the age of three years are
anemic. Under the National Nutritional Anemia
Prophylaxis Program (now part of RCH) Iron & Folic
acid tablet containing 20 mg of elemental Iron and
0.1mg of Folic acid are provided at sub center level.
Universal Immunization Programme
The impact of the UIP is measured in terms of Vaccine
Preventable Diseases (VPD) burden. Over the last 15 years
there has also been a general decline in the reported
number of cases of the six main VPD, Despite the
improvement indicated above, the stated goals were not
fully achieved, thus there is an urgent need to address the
immunization system deficiencies and emphasize the need
for strengthening the system and vigilant monitoring and
surveillance.
Urban Measles Campaign: A special
campaign was stated for slum areas in
1998 with assistance from UNICEF. In
1999- 2000, 50 cities were covered. The
emphasis is on covering all unprotected
children up to age of 3 years with single
dose of measles vaccine
Neonatal Tetanus elimination: All
women in reproductive age group should
be covered with three doses of Tetanus
Toxoid vaccine through a campaign
approach. Such campaigns have been
implemented in Rajasthan and Madhya
Pradesh to achieve early elimination of
neonatal tetanus.
Adolescent Health
Adolescent Health
Some of the public health challenges for
adolescents include pregnancy, excess
risk of maternal and infant mortality,
sexually transmitted infections and
reproductive tract infections in
adolescence, and the rapidly rising
incidence of HIV in this age group.
Strategy for addressing Adolescent
Reproductive and Sexual Health
Initiatives for
vulnerable groups
Strategy for addressing Adolescent
Reproductive and Sexual Health
(ARSH) in RCH Phase II:
It is proposed to provide adolescent
health services through the existing sub
centers/ PHCs and CHCs
Why vulnerable?
Poor connectivity to health centers
Lack of flexibility and reduced
responsiveness to local diversity and needs
Lack of appropriate Human Resource
Development (HRD) policy to
encourage/motivate the service providers
to work in remote and tribal areas
Goals:
To improve the health status of the
vulnerable population by ensuring
accessibility and availability of quality
primary health care and family welfare
services to them.
Objectives
To improve accessibility, availability and acceptability of health services
including RCH services by strengthening infrastructure including training
and skill development of service providers, improving the supply of
equipment, drugs etc. in an integrated and participatory manner
To bring them at par in this respect with the rest of the population, and
thus improving the aggregate indicators towards achieving the expected
results set under RCH Phase II by the end of 2010.
Mainstreaming Gender
and Equity
Mainstreaming Gender
and Equity
In India there is significant disparity in
health care utilization and health status
between women and men. Poor women
consume less health care resources and
suffer worse health than men and a
large and increasing share of health
expenditure by poor people is taking
place outside of the public sector
Mainstreaming Gender
and Equity
The aim of mainstreaming gender is to
correct imbalances between the position
of men and women in terms of access to
resources and benefits as well as to
understand the differences in terms of
health status and health determinants
Funds Flow Arrangement for RCH
Program
Ministry of Health & Family Welfare
(Govt. of India)
State treasurey
Monitoring and Evaluation
A comprehensive integrated Health management
information system will be functional in RCH - II.
Community Need Assessment and Monitoring
Approach (CNAMA) will be used. The work plans for a
particular year will originate from the sub center
level under each PHC and are subsequently
aggregate with appropriate additions at the CHC and
district levels
Strengths
Integrated and vast programme
Participatory approach
Lays great emphasis on training, IEC and research
Modern system of Management Information and
evaluation
Separate plan for each state
Services are client-centered, demand driven and
based on the needs of the community
Weakness
Difficult to be met by 2010
Socioeconomic development is the biggest
contraceptive.
Population stabilization
Shortage of manpower
Shortage of kits, drugs, vaccines and contraceptives
Referral system and feedback are not smooth
The quality indicators used to monitor and
evaluate RCH programme through the
monthly basis are :
Number of antenatal cases registered-total and
less than 12 weeks
Number of pregnant women who had 3 antenatal
check ups
Number of high risk pregnant women referred
Number of pregnant women with 2 dose of TT
Number of pregnant women under prophylaxis
and treatment of anemia
Number of deliveries by trained and un trained
birth attendant
Number of pregnant women referred to FRUs
Number of new born with birth weight recorded
Number of women with 3 post natal check ups
Number of RTIs and STI cases detected, treated and
refered
Number of children fully immunized
Number of adversed reaction reported after immunization
Number of cases of ARI and Diarrhoea under five years
treated , refered, to PHC/FRU and deaths,
14 Number of cases motivated and followed up for
contraception
MATERNAL AND CHILD HEALTH
FAMILY PLANING
MEDICAL TERMINATION OF PREGNANCY
NUTRITION
UIP
RECORD KEEPING OF VITAL EVENTS
DAIS TRAINING
JOB RESPONSIBILTY OF MALE
HEALTH WORKER
U.I.P
HEALTH EDUCATION
NUTRITION
R.C.H
ENVIRONMENTAL SANITATION
NURSES RESPONSIBILITIES IN
R.CH
ADMINISTRATION
MATERNAL AND CHILD HEALTH
PROGRAAME
FAMILY WELFARE
HEALTH EDUCATION
NUTRITION
VITAL STATISTICS
CLERICAL DUTIES
MANAGEMENT OF LABOUR
IIMEDIATE CARE OF NEW BORN
DAI TRAINING
HEALTH SUPERVISION
IMMUNIZATION
AS A HEALTH TEAM MEMBER
STUDENT TRAINER
EFFECTIVE PLANNER
CONCLUSION
TODAYS
CHILDRENS
ARE
TOMORROWS
HEALTHIER CITIZENS
