NEW INITIATIVES IN CHILD HEALTH

Dr Sangeeta SaxenaAssistant Commissioner(Child Health)Ministry of Healtrh and family Welfare

Government of india

2. CURRENT STATUS VIS-À-VIS RCH II/

NRHM GOALS RCH II Goal

IndicatorAll India Trends(Source of Data)

Targets for No. of states having achieved

10th Plan (2007)

RCH II /NRHM (2012)

10th Plan targets

RCH II /NRHM targets

MMR(per lakh live births)

398(SRS 1997-98)

254(SRS 2004-06)

<200 <100 8 1

IMR(per 1000 live births)

71(SRS 1997)

53(SRS 2008)

<45 <30 13 5

TFR 3.3(SRS 1997)

2.7 (SRS 2007)

2.3 2.1 10 9

Note: 1.Data covers first year of RCH II for MMR, and first half of RCH II for IMR and TFR.2.Union territories (except Delhi) have been excluded in the findings

21% of all under five deaths occur in India

Under-5 Mortality Worldwide

Rest of the world

7 million

Rest <5 deaths

0.6 million

Infant Deaths

1.6 millionIndia

2.2 million

Source: World Health Statistics, 2007

Under-5 deaths in India

Latest data shows that worldwide U-5 deaths have declined to 8.8 million, with India accounting for nearly 1.85 million.

72 7169

66 65

59 5856 55 54

52 5148 48 47 47

4339

37 37 36 35 34 34

2321

13 13 12

0

10

20

30

40

50

60

70

80

Mad

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Oris

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Mah

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Goa

Ker

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Man

ipur

INFANT MORTALITY RATE

13 states have met 10th Plan target

5 states have met RCH II/ NRHM target

RCH II Goal: '10

10th Plan Goal : '07

Source: RGI-SRS 2007

Breakup of causes of Breakup of causes of mortality (India)mortality (India)

INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD

DEATHSCAUSES INTERVENTIONS

Severe infections (36% deaths) IMNCI / F-IMNCI, Basic new born care, Early initiation of breast feeding

Preterm birth (25% deaths) NSSK

Birth asphyxia (23% deaths) NSSK

Neonatal tetanus (4% deaths) TT (mother)

INTERVENTIONS FOR ADDRESSING CAUSES OF CHILD

DEATHSCAUSES INTERVENTIONS

Acute respiratory infections (19% deaths)

Antibiotics, IMNCI

Diarrhoeal diseases (17% deaths) ORS, Zinc

Measles (4%) Immunization

Undernutrition Community and facility based management

Children’s Nutritional StatusChildren under age 5 years who are underweight (%)

2022 23

25 25 25 26 26

3033 33

36 37 37 38 38 39 40 40 40 41 42 4345

4749

56 5760

20

0

10

20

30

40

50

60

70

SK

MZ

MN

KE PJ

GA

NA

JK DL

TN AP

AR

AS

HP

MH

KA

UT

WB

HR

TR RJ

OR

UP IN GJ

CH

MG

BH JH MP

Source: NFHS-3

CHILD HEALTH: STRATEGIES• Integrated management of neonatal and childhood illnesses (IMNCI) and F

IMNCI– Pre-service and In-service training of providers – Improving health systems (e.g. facility upgradation, availability of logistics, referral

systems)– Community and Family level care

• Home Based Newborn and Child Care/ HBNCC

• Facility Based Newborn Care : SNCUs;Stabilization units;newborn corners

• Infant and Young Child Feeding– including Improving Early and Exclusive Breastfeeding and Complementary Feeding

• Nutritional Rehabilitation Centres

• Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases

• Supplementation with micronutrients: Vitamin A & iron folic acid

• School Health Program

Facility - Integrated Management of Neonatal & Childhood Illnesses (IMNCI)

• An integrated approach for sick infant & under-fives - Includes:– community and family level care

– improving health systems e.g. facility up gradation, availability of logistics, referral systems.

• Community IMNCI– Home visits for all newborns to teach the mother ways to prevent illnesses

through exclusive breastfeeding and essential newborn care.

– At these visits, mothers are also taught to recognize illnesses early and seek timely care.

PLUS• Asphyxia management

• Inpatient management of sick newborns and children

IMNCI (IN-SERVICE) IMPLEMENTATION STATUS

75

140

258

219

160

1400025500

46000

90401

202015

0

50

100

150

200

250

300

Sep-06 Jul-07 Dec-07 Dec-08 Mar-09

0

50000

100000

150000

200000

250000

No. of District

Personnel Trained

Source: NRHM MIS reports

F–IMNCI• To enhance the skills missing at facilities to manage newborn and

childhood illness.• Overcome the acute shortage of paediatricians in the country. No. of posts of paediatricians in rural health facilities:

– Required = 4276– Sanctioned = 1620– In position = 866

• The introduction of F-IMNCI will help bridge this acute shortage of specialists.

• There is also a need to simultaneously increase the number of sanctioned posts.

IMNCI Progress• IMNCI Implementation

– In 258 districts

– Over 2 lakh personnel trained

• Pre-service IMNCI– Introduced in to the curriculum of 79 Medical colleges

– Nearly 4000 students trained

First course of FIMNCI started on 10th November 2009

Navjaat Shishu Suraksha Karyakram

•A new programme on Basic Newborn Care and Resuscitation, launched nationally by GoI to address important interventions of care at birth:

Prevention of Hypothermia

Prevention of Infection

Early initiation of Breast feeding and

Basic Newborn Resuscitation.

•OBJECTIVE: To have one trained person at institutional facility, where deliveries take place.

•To be completed by June 2010

Community

PHC

CHC

District Hospital

Newborn corner

(1 bed)

At DeliverySick newborn

Stabilization units

(4 beds)

Special newborn care unit

(12-20 beds)

NSSK NSSK IMPLEMENTATIONIMPLEMENTATION

Sick Newborn Care Units (SNCUs)

Approximately 174 Special New Born Care Units (SNCU), 1592 Stabilization units and 4793 New Born Care Corner have been established at district hospital, CHC/FRU and 24-hour PHCs respectively.

5145 43 40

20 23

0

10

20

30

40

50

60

Stunted Underweight Wasted

NFHS-2 NFHS-3

Undernutrition in Children under Age 3

Percent

Nutrition• Nutrition is the primary responsibility of MoWCD

• MoHFW responsible for management of severe acute malnutrition, supplementation of micronutrients (Vitamin A & IFA to children, IFA to pregnant and lactating women).

• MoHFW also promotes breastfeeding and complementary feeding.

Nutrition Rehabilitation

Centre12 bedded units at DH, malnutrition managed by high calorie hot cooked locally

available foods and nutrition counselling

524 such units in place across states

7479

4 5

0

10

20

30

40

50

60

70

80

90

Any anaemia Severe anaemia

NFHS-2 NFHS-3

Anaemia among Children Age 6-35 Months

Percent

Vitamin A & IFA supplementation

• Vitamin A supplementation from 9 months to 5 years of age, every six months

• IFA supplementation with Iron Folic Acid, for 100 days in a year to children found clinically anaemic (syrup for children 6 months- 5 years, tablets thereafter)

• IFA supplementation for 100 days to all pregnant and lactating women.

School Health Programme

• School Health Programme (SHP) is currently being implemented in 33 States and UTs.

• Health check-up, treatment of minor ailments, health education, micronutrient supplementation, immunization, services are being offered in close conjunction with the Ministry of HRD

• State plans for SHP increased from Rs. 56.58 crores in 2007-08, to Rs. 65.04 crores in 2008-09, and 112.10 crores in 2009-10.

Thank You