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Guidance Note on Provision of Reproductive, Maternal, Newborn, Child,Adolescent Health Plus Nutrition (RMNCAH N) services during & postCOVID-19 PandemicIntroductionIn India, with the second largest global population, the growing epidemic of Coronavirus requiresthat special efforts have to be made to continue the essential routine RMNCAH N services. Withmore than 2.5 crore pregnancies each year in the country, it is important to ensure the availabilityof services during this period as any denial of services can have an impact on maternal and newbornmortalities, morbidities as well as the health care costs. Also unwanted pregnancies have negativeimpact on maternal and new born health. Regulating fertility is thus a necessity. There is need toenhance provision of safe abortion services besides post-partum and post abortion contraception.India also has the largest adolescent and youth population. Therefore, in addition to the currentpriority for COVID 19 for the health facilities and health workers, it is also vital that essential healthservices for vulnerable population like this segment are continued during the pandemic.MoHFW released the guidelines on “Enabling Delivery of Essential Health Services during theCOVID 19 Outbreak” dated 14th April 20201for provision of essential servicesThe guidelines outlined the following services as essential: Services related to pregnancy care and management New-born care and childhood illness management Immunization Services Management of SAM children Family Planning Services Comprehensive Abortion Care Services Adolescent Health servicesThe guidelines also mentioned the health system approach for delivery of these essential servicesincluding facility mapping and planning, alternate service delivery mechanisms (Telehealth,modified outreach, home visits), Triaging, Management of human resources, ensuring supplies ofmedicines and diagnostics, program management (including monitoring), finances andaccountability systems.The following Guidance Note on Provision of Reproductive, Maternal, Newborn, Child, AdolescentHealth Plus Nutrition (RMNCAH N) services during & post COVID-19 pandemic elaborates thevarious RMNCAH N services to be provided at different levels in accordance with the zonalcategorization of Containment Zones & Buffer Zones and beyond these icesduringCOVID19updated0411201.pdf)Page 1

Zonal Categorization (based on COVID 19 Risk Assessment):Districts/Sub-Division/Municipal Corporation/Ward or anyother appropriate administrative units are categorized into:oGreen Zone: No active COVID-19 casesoRed & Orange Zone: Active COVID-19 casesAreas where COVID-19 cases are reported have been classifiedas Containment zone and surrounding areas with risk forCOVID-19 spread are termed as buffer zone.For RMNCAH N purposes, services have been bifurcated into:1. Containment & Buffer Zoneand2. Areas beyond Buffer Zone & Green ZoneRMNCAH N GuidelinesAll RMNCAH N activities will follow certain guiding principles (these are general principles andneeds to be followed for all the RMNCAH N activities).General Guiding Principles: Guidelines and updates from MHA and MoHFW will override any other guidelines.Any area exiting a ‘containment/ buffer zone’ can start RMNCAH N activities as listed in‘areas beyond buffer zone’ after a minimum gap of 14 days following delisting.Similarly, an area entering a ‘containment/buffer zone’ should restrict RMNCAH Nactivities immediately as outlined in ‘Containment/Buffer Zone’.Not for Profit/private sector hospitals can be involved in provision of non COVID essentialservices, wherever public sector capacity needs to be supported.Practices of physical distancing, hand washing, and respiratory hygiene need to bemaintained at all service areas by all beneficiaries and service providers.Facilities should follow a staggered approach, wherein adequate seating space forbeneficiaries and caregivers with physical distancing is ensured.In case the number of beneficiaries is more, then additional sessions/clinics could beorganizedCommunity based activities should have limited participation (5-10) at a time.The procedure site and all equipment should be sanitized properly before and after theclinics/sessions.The health care providers and Front-Line Workers (FLWs) to use appropriate PersonalProtective Equipment (PPEs) as per guidelines and monitored regularly for ipment.pdf)Page 2

Specific Guiding Principles for provision of RMNCAH N services: All COVID suspect and positive cases should preferably be provided services at dedicatedCOVID facility.COVID testing is not mandatory for RMNCAH N service. ICMR testing guidelines needto be followed.Teleconsultation services to be promoted at all levels to prevent overcrowding and reducecross infection.Drugs, commodities needed for continuing RMNCAH N services, should be treated asessential commodities.Home deliveries of essential medicines like IFA, Calcium, ORS, Zinc, contraceptives etc.can be organized in containment zone.Capacity building of all healthcare providers, review meetings etc. should preferably becarried out using digital health platforms.Campaign mode services:Following campaign mode services can be provided on an alternative mechanism likethrough home delivery of essential services & commodities etc. based on local situation:o Mass vitamin A prophylaxiso Campaigns for Intensified Diarrhea Control Fortnight (IDCF)o National Deworming Day (NDD)o Test treat and Talk (T3) camps for Anemia.Note: Critical services for women, children and adolescent should be providedirrespective of their COVID status. Under no circumstances should there be a denial of essential services.Page 3

Maternal HealthProgramactivitiesContainment & Buffer ZoneAntenatalServices VHSND/UHSND should not be organized PMSMA should be deferred ANC services should be limited for walkin beneficiaries in facilities.Line listing of High Risk Pregnanciesshould be maintained and follow upshould be through teleconsultation.beneficiary visit should be organized tothe hospital located outside ContainmentZoneHouse to house visit conducted by HealthWorkers/COVID warriors for COVIDpurpose should be utilized to enquireabout services required for pregnantwomen and linkages to the requiredservice should be provided.COVID warriors may be trained in theseservices, if requiredUninterrupted ANC servicesPMSMA to be continuedModified VHSND/UHSND All health facilities should continue providing delivery services Birth companion should be avoided during deliveryAll health facilities shouldcontinue providing deliveryservicesBirth companion should beavoided during delivery in areasbeyond buffer zone and norestriction in green zone DeliveryServicesPostnatalCare Beyond Buffer Zone & GreenZonePostnatal care through teleconsultation. House to house visit conducted by HealthWorkers/COVID warriors for COVIDpurpose should be utilized to enquireabout services required for postnatalmothers and linkages to the requiredservice should be provided.COVID warriors may be trained in theseservices, if requiredUninterrupted PNC services at allhealth facilities and house visitsby ASHAs should be continued.Specific guidance for Maternal Health Services: Every pregnant woman is to be linked with theappropriate nearby health facility for delivery and ambulance services to be tied up in advance fortimely transport.Page 4

Newborn & Child HealthProgrammaticactivitiesCare of sicknewborn,Follow up ent & Buffer Zone HBNC andHome BasedYoung ChildCare (HBYC) RBSK Services to sick new born (irrespective of COVID status) should be providedin the nearest SNCU/NBSU. Alsoproper referral arrangement should beensuredRoutine SNCU follow-up throughteleconsultation,however,sicknewborn showing danger signs to bereferred to nearest SNCU with properreferral arrangementFamily Participatory Care in SNCUshould be suspended.House to house visit conducted byHealth Workers/COVID warriors forCOVID purpose should be utilized toenquire about services required forchildren and linkages to the requiredservice should be provided.COVID warriors may be trained, ifrequiredBeyond Buffer Zone & GreenZoneAll services should becontinued as per guidelinesHBNC/HBYC services should be HBNC/HBYC visits should beprovided through teleconsultation.continued as per guidelines.House to house visit conducted byHealth Workers/COVID warriors forCOVID purpose should be utilized toenquire about services required forchildren and linkages to the requiredservice should be provided.COVID warriors may be trained, ifrequired.Newborn screening should be done at Screening of children throughall health facilities where deliveriesMobile Health Teams shouldhave taken placebe deferred till schools andScreening of children through MobileAWCs reopen.Health Teams should be deferred DEICshouldcontinueDEIC services should be provided onsupportingchildrenfordemand to walk-in beneficiaries inmanagement of 4Ds.facility.Page 5

ProgrammaticactivitiesContainment & Buffer Zone Management of SAM children withcomplications at NRC Beyond Buffer Zone & GreenZoneTreatment of children with 4Ds shouldbe continued in all the designatedhospitals.Services to sick SAM should be provided in the nearest NRCProper referral arrangement should beensuredRoutinefollow-upthroughteleconsultation should be providedHouse to house visit conducted byHealth Workers/COVID warriors forCOVID purpose should be utilized toenquire about services required forchildren and linkages to the requiredservice should be provided.COVID warriors may be trained, ifrequired.Management of sick SAMchildren should be continuedas per existing guidelines.Specific guidance for Newborn and Child Health Services: Mother and baby to be nursedtogether as far as possible and breastfeeding to be initiated within 1 hour of delivery, irrespective ofCOVID status. However, she should put on a facemask and practice hand hygiene before eachfeeding.ImmunizationProgrammatic Containment & Buffer ZoneactivitiesBirth dosevaccinationTo be continued at all health facilities as the beneficiaries are already in thefacility ImmunizationBeyond Buffer Zone &Green Zone Immunization services on demand to walk- in beneficiaries in facilityNo outreach session (VHSND/UHSND)No active mobilizationBoth facility based andoutreach sessions to beconducted with modifiedVHSND/UHSNDPage 6

Adolescent HealthProgrammaticactivitiesAdolescentFriendly HealthClinics (AFHCs)andAdolescentHealth Days(AHDs)Containment & Buffer Zone Beyond Buffer Zone & GreenZone AFHCs to conductteleconsultation of adolescentsand provide services on demandto walk-in beneficiaries AFHC to remain operationalAHD-modified services shouldbe provided to avoid crowdingas per in guiding principlesCommunity distribution of IFAtablets and Sanitary Napkins tobe carried outSpecific guidance for Adolescent Health Services: To address anxiety and psycho-social issuesamong adolescents, peer-based counselling/teleconsultation/helpline to be initiated by involvingAFHC Counsellors.Reproductive HealthProgrammaticactivitiesContainment & Buffer ZoneBeyond Buffer Zone & GreenZone Static services should be providedon demand to walk-in beneficiariesin facility Fixed Day services (FDS) should beprovided by ensuring 10 clientsper day in designated facilities Family PlanningSterilizationservices (FDSand staticservices)Post-partumsterilization/Post abortionsterilization Postpartum services should beprovided to beneficiaries who arealready in facilityIUCD IUCD Should be provided ondemand to walk-in beneficiaries infacilityPPIUCD PPIUCD should be providedconcurrent with deliveryPAIUCD PAIUCD should be providedconcurrent with surgical abortion All services should be providedas per guideline avoidingovercrowding and maintainingphysical distancingFixed Day services (FDS)should be provided by ensuring 10 clients per dayMore sessions be organized, ifneededPage 7