Child Heath- status and

Initiatives in Gujarat

Dr Siddharth Nirupam

Presentation outlineCurrent Status of Child Heath

Mortality trendsCauses of Child DeathChild Nutrition

Priority intervention (within continuum of care)Programme Thrust- Reaching the Unreached

Where are the unreached- mapping and HP areasWhy they are not reached- barrier identification and

action

Trend of Infant Mortality Rate (IMR)

in Gujarat54 53 52

5048

4441

3835

29

24

0

10

20

30

40

50

60

2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2017

IMR

per

100

0 Li

ve B

irth

s

@ 1 per year i.e.

1.9%

@ 2 per year i.e. 2.8

& 4 % @ 4 per year i.e. 8.3 %

@ 3 per year i.e. 6.8 & 7.3 %

NRHM Chiranjeevi

108 NirogiBal

BalSakhaSource: SRS Infant Mortality Estimates

Causes of under- Five Death

Too Thin for Age Too Thin for Height

Normal %[Green]

Severe Under Weight %

(Red)

Moderate Under Weight

% [Yellow] Moderate Acute

Malnutrition (MAM) %Severe Acute

Malnutrition (SAM) %

44.6%

Underweight (%)

55.4%

28.3%

16.3% 5.8

%

12.9%18.

7%

Wasting (%)

Source:- NFHS- 3 (2005-06)

Child Nutrition Status - Gujarat

1. Improving new born care – Home and facility

2. Diarrhea and Pneumonia - Prevention & Management

3. Routine Immunization with equity focus

4. Child Nutrition- IYCF; Malnutrition management

Priority Interventions for Child Health

Gujarat’s Child Health Programme within Continuum of Care

Time Period

KPSY-1 KPSY-2

KPSY-3

3 levels of care- Family care, outreach, Facility

VHND – Mamta Abhiyan, e Mamta

JSSK, FRU

FBNCNSSK

IMNCI Plus

Ad

ole

sc

en

t

Chiranjeevi Yojana

JSY

RSBY Bal Sakha Ext. BalSak (Trbl Bloks)

MA

Follow up of LBW & SCNU Discharged

EMRI-108 Khilkhilat

N U T R I T I O N M I S S I O N

Evaluated Achievements of key Interventions across life stages- Gujarat

Data source: CES 2009;DLHS 3(%-National Average)

Newborn Care Continuum

Role of Private Sector - (Diarrhoea)

ORS Use RateCurative care & Private SectorCES -2009

Undernutrition in Gujarat

coverage of 10 proven interventions for its reduction

Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India***Coverage Evaluation Survey, UNICEF,2009BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition

The Goal 100%

%

Where are The unreached?

Reaching the Unreached for Child Health

41 48

27

Latest SRS reference -2009 by RGI

Goal 27

Death rates higher in rural but Urban poor death rates > urban averageIMR in ST > State average

IInfant Mortality trends- Rural Vs Urban

Immunization Status by Wealth Quintile, Gujarat

Coverage Evaluation Survey, 2009

DLHS-3

Disparity in Infant Feeding by District

3. CF: Timely Introduction

1. BF: Timely Initiation 2. Exclusive BF: 0-6 mo

IYCF: Composite Index (1+2+3)

Gujarat High Priority Districts (8)

HPD and Tribal districts

HPD but not Tribal districts

Why are they unreached?

Reaching the Unreached for Child Health

18

Six Coverage determinants- Tanahashi Model

Availability of drugs/suppliesAvailability of drugs/supplies

Availability of Human ResourcesAvailability of Human Resources

Geographical AccessGeographical Access

Utilization Utilization -first contact-first contact

Effective Coverage -qualityEffective Coverage -quality

Adequate Coverage Adequate Coverage -continuity-continuity

Immunization Coverage- where is the gap

From Tanahashi T. Bulletin of the World Health Organization, 1978, 56 (2)http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf

Availability – critical inputs to health system

Adequate coverage- continuity

Utilisation – 1rst contact with services

Accessibility – physical access to services

Effective coverage- quality

Target Population

Accessibility – to human resources

Availability of Vaccines and Supplies (near 100%)

Availability of vaccinator (near 100%)

Functional Access to Mamta diwas (near 100%)

Initial Utilization (BCG coverage ( >95%- DLHRS 11)

Continuous (Measles coverage (79%)

Fully Immunized (69%)

Immunization Program- aim 100% coverage

Some Common Bottlenecks in Child Health Programming in IndiaLimited availability of Human ResourcesLow availability and access to Child Health

in some areas- e.g. UrbanLow Demand generation in some areas Low skill building- e.g. Facility Newborn

careTransport/ communication gaps in difficult

areasInadequate supervisionData Quality

Suggested Issues for Child Health ProgrammingUnreached Areas

Rural- Drilling down to at least taluka level for local barrier analysis and local solutions

Urban Poor- Mapping, infrastructure, service delivery, MISChild Malnutrition- Experiences from other countries-

IYCF communication; SAM management; MicronutrientsGram Sanjivini Samiti - Increasing community

participationEmergency Transport- number and type for difficult

areasStrengthen Supportive supervision for skills and quality Private sector- Evolving relationship

Thanks