RMNCH+A Programme in India:
Introduction
• The health of women, children, and adolescents forms the foundation of a nation’s overall well-being and progress. In India, ensuring equitable access to quality healthcare for these vulnerable groups has always been a priority. To address this need, the RMNCH+A Programme (Reproductive, Maternal, Newborn, Child and Adolescent Health Programme) was launched by the Government of India in 2013 under the National Health Mission (NHM).
• The RMNCH+A strategy marked a significant shift from fragmented approaches to an integrated and continuum-of-care model. It focuses not just on reproductive and maternal health but also expands services to newborns, children, and adolescents. By linking these stages of life, the programme ensures comprehensive healthcare delivery at every step.
• This article provides a detailed look into the RMNCH+A Programme in India—its background, objectives, components, strategies, achievements, challenges, and future scope.
Background of RMNCH+A Programme in India
Before the launch of RMNCH+A, India had multiple programmes addressing reproductive and child health separately. These included the Child Survival and Safe Motherhood (CSSM) Programme (1992) and the Reproductive and Child Health (RCH) Programme (1997). While these initiatives improved maternal and child health indicators, they lacked integration across different age groups and health needs.
The RMNCH+A Programme, introduced in 2013, brought a broader perspective by:
• Including adolescents as a distinct group.
• Ensuring continuum of care from adolescence → pre-pregnancy → pregnancy → childbirth → postnatal period → childhood → adolescence again.
• Strengthening healthcare delivery at various levels (community, sub-centre, PHC, CHC, district hospital).
Objectives of RMNCH+A Programme
The primary goals of RMNCH+A Programme are to:
1. Reduce Maternal Mortality Ratio (MMR).
2. Reduce Infant Mortality Rate (IMR).
3. Reduce Under-Five Mortality Rate.
4. Reduce Total Fertility Rate (TFR).
5. Improve Adolescent Health through education, nutrition, and reproductive health services.
6. Strengthen healthcare delivery system at community, primary, secondary, and tertiary levels.
Key Components of RMNCH+A Programme
The RMNCH+A framework is based on six strategic pillars:
1. Reproductive Health
• Promoting family planning services.
• Access to contraceptives and counseling.
• Safe abortion services where legal.
• Infertility treatment support.
2. Maternal Health
• Safe motherhood initiatives.
• Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK).
• Ensuring institutional deliveries.
• Emergency obstetric care.
3. Newborn Health
• Facility-based newborn care units (FBNC).
• Special newborn care units (SNCUs).
• Early initiation of breastfeeding.
• Kangaroo mother care for low birth weight babies.
4. Child Health
• Universal immunization programme.
• Integrated management of neonatal and childhood illnesses (IMNCI).
• Nutrition supplementation under POSHAN Abhiyaan.
• Management of diarrhea and pneumonia.
5. Adolescent Health
• Rashtriya Kishor Swasthya Karyakram (RKSK).
• Adolescent-friendly health clinics.
• Education on sexual and reproductive health.
• Anemia control programmes (Weekly Iron Folic Acid Supplementation).
• Mental health counseling.
6. Systems Strengthening
• Strengthening primary health centres and sub-centres.
• Capacity building of healthcare workers.
• Use of technology for monitoring and data collection.
• Public-private partnerships.
Strategies Adopted Under RMNCH+A
• The RMNCH+A Programme operates on the Continuum of Care Approach, which ensures that every individual receives health services at critical stages of life.
Key strategies include:
1. Integration of services across reproductive, maternal, newborn, child, and adolescent health.
2. Community participation through Accredited Social Health Activists (ASHAs).
3. Facility-based interventions including emergency obstetric and newborn care.
4. Outreach services like Village Health and Nutrition Days (VHNDs).
5. Equity focus ensuring services for vulnerable and marginalized groups.
6. Monitoring and evaluation for accountability and improvement.
Achievements of RMNCH+A Programme
• The RMNCH+A Programme has contributed significantly to improving health indicators in India:
• Maternal Mortality Ratio (MMR) reduced from 167 (2011–13) to 97 per 100,000 live births (2020).
• Infant Mortality Rate (IMR) dropped from 44 (2011) to 27 per 1,000 live births (2020).
• Under-Five Mortality Rate declined steadily, reaching 32 per 1,000 live births (2020).
• Increase in institutional deliveries due to JSY and JSSK.
• Expansion of Special Newborn Care Units (SNCUs) across districts.
• Increased focus on adolescent health through RKSK and WIFS programme.
Challenges of RMNCH+A Programme
Despite progress, the programme faces several challenges:
1. Unequal access to quality healthcare across rural and urban areas.
2. Shortage of trained health workers and specialists in rural areas.
3. High adolescent health risks due to lack of awareness and stigma.
4. Nutritional deficiencies among women and children.
5. Regional disparities in maternal and child health indicators.
6. Limited infrastructure in some district hospitals and PHCs.
7. Social barriers such as early marriage, gender inequality, and low education levels.
Way Forward for RMNCH+A Programme
To achieve the Sustainable Development Goals (SDGs) by 2030, India needs to further strengthen the RMNCH+A approach by:
• Expanding telemedicine and digital health platforms.
• Enhancing nutrition interventions for women and children.
• Improving adolescent mental health services.
• Strengthening public-private partnerships.
• Addressing socio-economic determinants like poverty, education, and sanitation.
• Ensuring universal health coverage under Ayushman Bharat and Health and Wellness Centres.
Conclusion
The RMNCH+A Programme in India has been a milestone in integrating reproductive, maternal, newborn, child, and adolescent health services into a single continuum of care framework. While challenges persist, the programme has significantly improved key health indicators and laid a strong foundation for achieving universal health coverage. With continuous efforts, India can further reduce maternal and child mortality and create a healthier future for its population.
FAQs on RMNCH+A Programme in India
1. What is the full form of RMNCH+A?
The full form of RMNCH+A is Reproductive, Maternal, Newborn, Child and Adolescent Health Programme.
2. When was the RMNCH+A Programme launched in India?
The RMNCH+A Programme was launched in 2013 under the National Health Mission (NHM).
3. Why was the RMNCH+A Programme introduced?
It was introduced to integrate services for reproductive, maternal, newborn, child, and adolescent health into a single continuum of care, improving access and outcomes.
4. What are the key components of RMNCH+A?
The programme covers reproductive health, maternal health, newborn health, child health, adolescent health, and health systems strengthening.
5. How does RMNCH+A benefit adolescents?
Through the Rashtriya Kishor Swasthya Karyakram (RKSK), adolescents receive counseling, nutrition supplementation, sexual health education, and mental health support.
6. What achievements has the RMNCH+A Programme made?
It has reduced maternal and child mortality, increased institutional deliveries, improved immunization coverage, and established adolescent-friendly services.
7. What challenges does RMNCH+A face?
Challenges include rural-urban disparities, shortage of trained staff, malnutrition, adolescent health risks, and social barriers.
8. How is RMNCH+A linked to Sustainable Development Goals (SDGs)?
The programme contributes to SDG 3 (Good Health and Well-being) by reducing maternal and child mortality and ensuring universal health coverage.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)