Child Survival and Safe Motherhood Programme (CSSMP)

India has high maternal mortality, (5/1000 livebirths) and high infant mortality (80/1000 livebirths). This is at least ten times higher than most of the developed countries. There is wide variation in these indices from state to state and from district to district.  The major reasons for high maternal and infant deaths are poor utilisation of services, lack of knowledge of such facilities, inaccessibility, belief in traditional remedics, low female education and poor rapport of health workers. Our health system has been focussing so far on specific programmes and not on total needs of mothers and children. The CSSM Programme attempts to deliver the maternal and child health services as a package programme considering the total needs of mothers and children during health and disease. The programme was launched in 1991 in 100 district of the country covering the states of Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh. 

Objectives 

The general objective of the programme is : to reduce maternal mortality to less than 2, infant mortality to less than 50 per 1000 livebirths; and child mortality (1 to 4 years of  age) to below 10 by 2000 A.D. This is to be achieved through improvement  and expansion of Maternal Child Health (MCH) services at village, sub-centre, PHC and CHC levels; improving the access to MCH services at village and sub-centre level, focusing on high IMR districts and improvement in support systems  such as training, supply, communication, monitoring and evaluation. 

The specific objectives  of the programme are : 

1. To reduce infant mortality rate from 80 to 75 by 1995; and to 50 by 2000 A.D. 
2. To reduce child (1-4 years) mortality rate from 41.2 to 10. 
3. To reduce maternal mortality rate from 5 to 2 per 1000 livebirth. 
4. To achieve  polio eradication by 2000 A.D. 
5. To eliminate neofiatal tetanus by 1995. 
6. To prevent 95 per cent measles death5 and 90 per cent cases of measles by 1995. 
7. To ensure prevention of 70 per cent diarrhoea1 deaths and reduce diarrhoeas cases by 25 per cent. 
8. To prevent 40 per cent deaths due to Acute Respiratory Infections. (Source : Child Survival and Safe Motherhood Programme Guidelines, Ministry of Health and Family Welfare, Government of India, 1992). 

Package of Services under the CSSM Programme : The services provided to children and pregnant mothers include: 

For Children 

1. New born care at home. 
2. Primary Immunisation by 12 months (100 per cent coverage). 
3. Vitamin A prophylaxis (9 months to 3 years) (100 per cent coverage). 
4. Correct management of pneumonia at home/at health facilities. 
5. ORT at home/health facility; ORS in every village for management of diarrhoea. 

For Pregnant Women : 

1. Anaemia prophylaxis and therapy (100 per cent coverage). 
2. Antenatal check-ups, at least 3 check-ups (100 per cent coverage). 
3. Referral of those with high risks and complications. 
4. Care at birth and promotion of clean delivery. 
5. Birth time and spacing.

The Important causes of the maternal  mortality  in India are anaemia, puerperal sepsis (infection in mother after delivery) heammorhages, malpositions (abnormal position of foetus in the  mothers womb) toxaemia and abortions. The maternal mortalily can be reduced to a great extent provided adequate care is ensured to women during pregnancy and delivery. For this, the health workers play a very crucial role.