The Millennium Development Goals Linkages with Child Health

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The Millennium Development Goals Linkages with
Child Health
The Challenge in India

• Dr. KANUPRIYA CHATURVEDI
• Dr .S.K CHATURVEDI

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Millennium Development Goals

• In the United Nations Millennium Summit in 2000,
  147 countries adopted MDGs
• Eradicate extreme poverty and hunger by half
  relative to 1990
• Achieve universal primary education
• Promote gender equality and empower women
• Ensure environmental sustainability
• Reduce child mortality by two thirds relative to
  1990
• Improve maternal health, including reducing
  maternal mortality by three quarters relative to
  1990
• Prevent the spread of HIV/ AIDS, malaria and
  other diseases
• Develop a global partnership for development

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The Global Challenge

• Nearly half the MDGs relate to health nutrition
• The targets cover a large share of the burden of
  disease deaths among poor people
• Child mortality 10.4 million/y
• Maternal deaths 0.5 million/y
• AIDS 2.9 million/y
• TB 1.6 million/y
• Malaria 1.1 million/y
• Illness, death, malnutrition impede economic
  growth contribute to income poverty

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Goal 4 reduce child mortality

• Goal 4 reduce child mortality
• Reduce by two thirds, between 1990 and 2015, the
  under-five mortality rate.
• Close to 11 million children die every year
  before reaching the age of five, or 20 per
  minute,30,000 per day. Nearly 4 million of these
  die in the first 28 days of life.
• Most of the deaths are due to a handful of causes
  (pneumonia, diarrhoea, measles, malaria, and
  neonatal causes).
• Malnutrition is associated with 54 of the
  deaths.
• 99 of the deaths are in low and middle-income
  countries, mostly in sub-Saharan Africa and South
  Asia.
• Measles deaths world-wide dropped by nearly 40
  between 1999 and 2003, with the largest reduction
  in Africa.

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Countries with most under-5 deaths, 2000
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Goal 5 Improve maternal health

• Every year, at least 529,000 women die in
  pregnancy or childbirth. 99 of these occur in
  the developing world.
• For every woman who dies in childbirth, around 20
  more suffer injury, infection or disease -
  touching approximately 10 million women each
  year.
• Complications resulting from unsafe abortions
  account for 13 of all maternal deaths.

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Avoidable maternal deaths each year
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Goal 6 Combat HIV/AIDS, malaria and other
diseases

• Every day, 8000 people die of AIDS-related
  conditions or some 3 million deaths per year.
  Only 400 000 of the five to six million people in
  the advanced stage of the disease had access to
  the anti-retroviral therapy in developing
  countries at the end of 2003.
• There are 8.8 million new cases of tuberculosis
  (TB) a year. There are 5500 deaths a day, or
  million deaths worldwide each year from TB. Some
  80 of this morbidity and mortality from TB falls
  on 22 high-burden countries.
• There are almost 300 million cases of acute cases
  of malaria each year. More than a million cases
  of malaria are fatal each year. Some 90 of the
  burden falls on tropical Africa, where malaria is
  a major cause of mortality and morbidity in
  children under five years of age.

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Challenges in India
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MDG4- Reduce child mortality

• Infant and Young Child mortality remains
  unacceptably high.
• About 2.4 million deaths occur annually in
  under-5 year-old children in India. Seven out of
  every 10 of these are due to diarrhea, pneumonia,
  measles, or malnutrition and often a combination
  of these conditions.
• In India abut 30 of children born with LBW.

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Goal 4. Reduce child mortality Infant Mortality
Rate
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MDG5- Improve maternal health

• 130000 deaths an year
• Equivalent to maternal Deaths in a year in India
• Every day in the year
• Every six minute in India
• For every Maternal Death 20 mothers start
  leading a life in the morbid conditions.
• Every here 1- 1.25 lakh children get MDS
  (Maternal Deprivation Syndrome)

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Direct causes of Maternal Deaths

• Haemorrhage (Antepartum Postpartum).
• Pregnancy Induced Hypertension Eclampsia.
• Sepsis Septicaemia.
• Obstructed Labour Ruptured Uterus.
• Septic Abortion.
• Other Causes.

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MDG6- Combat HIV/AIDS, malaria and other diseases

• Halt and begin to reverse the spread of HIV/ AIDS
• Sentinel surveillance optimal way of measuring
  infection among high and low risk groups
• Number of sentinel sites and their location an
  indicator of adequacy of coverage

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People living with HIV
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Combat malaria and other diseases

• Target Halt by 2015 and begin reversal of
  incidence of malaria and other major diseases

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Why a special effort now?

• New political and financial commitments
• Renewed focus on building sustainable health
  systems and financing
• Successful implementation builds confidence that
  scaling up of known interventions can accelerate
  progress on MDGs
• Processes and mechanisms emerging to improve
  donor harmonization and aid effectiveness

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But rapid gains are possible through

• Practical approaches to achieve the MDGs- key
  interventions and policies
• Changes in national policies strategic
  directions, capacity building, and financial
  support
• Stronger health systems
• Complementary actions across sectors (education,
  water, energy, transport)
• Donor mobilization and harmonization
• We can learn from success stories

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Evidence based interventionsEstimated U5 Deaths
Prevented With Universal Coverage

• Preventive interventions Proportion of all
  deaths ()
• Breastfeeding 13
• Insecticide treated materials
  7
• Complementary feeding 6
• Zinc 5
• Clean delivery 4
• Water, sanitation, hygiene 3
• Newborn temperature management
  2
• Tetanus toxoid 2
• Vitamin A 2
• Measles vaccine 1

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Evidence based interventionsEstimated U5 Deaths
Prevented With Universal Coverage

• Treatment interventions Proportion of all
  deaths ()
• Oral rehydration therapy 15
• Antibiotics for sepsis 6
• Antibiotics for pneumonia 6
• Antimalarials 5
• Zinc 4
• Newborn resuscitation 4
• Antibiotics for dysentery 3
• Vitamin A lt1

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Policies

• For scaling up education with investments in
  schools, teachers and supplies
• For scaling up of health with investments in
  health staff, doctors, health facilities, medical
  and paramedical training for maternal care,
  IMNCI, supplies of drugs/ equipment
• More decentralized planning and community
  involvement and public private partnership
• Gender equality and rights for women
• To pursue huge quick wins for health goals

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Examples of rapid gains in Health sector

• Training of large number of village workers to
  ensure basic expertise, services and counseling
• Distribution of free ORS, Disposable delivery
  kits (DDK), contraceptives, Iron- folic acid
  Vitamin A, anti-malarial insecticide
  impregnated bed nets in Malaria endemic areas
• Elimination of user fees for basic health
  services financed by increased domestic and Donor
  resources.

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What does this mean for India

• Develop credible strategies and plans to reach
  MDGs as part of PRSP and public expenditure
  program
• Improve governance and policy environment
• Commit domestic resources
• Improve monitoring and evaluation of results

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Examples of rapid gains in Health sector

• Expanding access to RCH services by focusing on
  out reach services, making health facilities
  functional and ensuring supplies and logistics
• IEC and Program communication to increase access
  to information, motivating for family/community
  actions and use of services
• Expansion of use of proven effective drug
  combinations for AIDS, TB, Malaria, Diarrhea and
  ARI( pneumonia and Asthama)

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Approach Service delivery mode based planning of
interventions

• Scaling interventions with high efficacy- family
  and community based interventions
• Making universally accessible- the outreach
  services
• Institution based and individual child centered
  services like malnutrition management facilities

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Data sources

• IMR and Child mortality
• Sample registration system (SRS) at national and
  state level- fairly accurate
• National Family Health Survey) NFHS- fairly
  accurate
• RCH district rapid household surveys low
  precision
• Causes of mortality--RGI
• Fairly elaborate and reliable
• Delay in sharing collated information
• Recent Involvement of Medical Colleges--Quality
• Disaggregated data for urban and rural India

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Data sources

• MMR
• Direct methods- large sample size required
• Indirect methods
• Snow ball technique
• House- to house survey- better
• Sisterhood method
• Estimating from sex differentials in mortality at
  reproductive ages involving regression techniques

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Data sources

• HIV/ AIDS/ Malaria/ TB
• Reports from program implementers
• Under reporting of incidence/ prevalence/ deaths
• Over reporting of cure rates to meet the targets

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Reasons for the shortfall

• Availability-
• Adequacy of supply- satisfactory
• Periodicity a bottleneck
• Quality of equipment/ drugs- need improvement
• Accessibility-
• Difficult to reach areas- neglected
• Gender and socioeconomic discrimination
• Round the clock services questionable
• Accessibility of govt services in urban areas
  
  

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Reasons for the shortfall

• Utilization
• Lack of awareness about services
• Irregularity of services
• Quality not always maintained
• Adequate coverage
• Drop outs- a common factor
• Effective coverage
• Skills of workers always not up to the desired
  level

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Costs and benefits

• Existing system takes into account supplies,
  staff and minimal on infrastructures
• Five country assessments and estimates indicate
  that annual public investments or MDGs will be
  80US per person in 2005-6 scaling up to 124 US
  in 2015

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Creation of national / state / district level
processes for scaling up

• Child Survival Partnership Recommendations
• Ensure effective convergence of all departments,
  public and private sector developing
  partners,..
• Prioritize the household and community-level
  interventions
• Face real challenge of reaching high levels of
  effective coverage with evidence-based
  interventions among under-privileged community
• Address operational bottlenecks management
  issues
• Work efficiently with community-level private
  providers.
• Public Private partnership efforts, involvement
  of NGOs
• Other Initiatives
• Public Private Partnershipin Immunization,
  Integrated Management of Childhood illnesses
  (IMNCI)