India’s RMNCH+A Strategy: approach, learnings and limitations

Abstract

Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

Enablers and Barriers to the Utilization of Antenatal Care Services in India

“…Contrary to past studies [37,50,51], distance to health facilities was not associated with ANC service use in our study. The Government of India health initiative (the National Rural Health Mission) [17] that expanded MCH services to disadvantaged rural areas may have played a role in our finding. Women’s exposure to mass media (newspapers or magazines and television) was associated with ANC service use, and this is consistent with past studies [10,18].…”

“…To improve ANC uptake among Indian women and other MCH outcomes, the Government of India has recently launched new MCH schemes, including the Pradhan Mantri Matru Vandana Yojana, Pradhan Mantri Surakshit Matritva Abhiyan, and LaQshya programmes [43,44]. While these initiatives are useful and required, the assessment of how successful and impactful these programs are may need to be documented in the scientific literature, consistent with a previous program [17], to guide future MCH programmes in India.…”

“…Nevertheless, it is uncertain whether these factors have changed in the past 10 years in India, given the improvements in household economic and educational status [14], social mobility of women [15,16], and the implementation of the Government of India maternal and child health interventions. These programs included the National Rural Health Mission (2005), the National Urban Health Mission (2008), and the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Strategy, introduced in 2013 to improve maternal and child health outcomes, including promotion of ANC service use [17]. Understanding the contextual factors that influence a mother’s decision to attend, or not to attend ANC is crucial to healthcare practitioners and policymakers, as it can offer relevant information and opportunities for targeted policy interventions.…”

Maternal health status in tribal India: A 5-year intervention program and its outcome

“…Lack of a dedicated monitoring and evaluation framework and an inability to address social determinants of health were some of the factors found to have reduced the impact of the RMNCH + A strategy. [ 19 ] The MIS system assisted field staff to efficiently evaluate and monitoring social indicators and record the health outcomes, and self-performance audit improved data collection and data entry/analysis. The manpower (capacity building) development of primary health workers imparted through regular task-oriented and hand-on AV-aided training program also improved health literacy and technical capabilities.…”

Life-conditions and anthropometric variables as risk factors for caries in children in Ladakh: A cross- sectional survey.

“…Education is free of charge and compulsory from the age of 6 to 14 years [1]. Indian Government reports Ladakh to be one of the districts that are below standards regarding health services and conditions [2]. The complex terrain and diverse topography of the plateau provides a unique climate.…”