CHILD HEALTH STRATEGY RCH II/NRHM Initiatives in Pipeline

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CHILD HEALTH STRATEGY RCH II/NRHM
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National goals MDG context
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Perceptible decline in U5MR (Needs acceleration
to gt7 points to achieve NRHM goals) Slow decline
in IMR Slower decline in the neonatal mortality

NFHS
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Neonatal Mortality Rate
1980-1990
25
1991-2000
15
Source SRS data
5
About half of child deaths occur in the neonatal
period (ICMR Study 2003)

• When do neonates die die?

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Child/Neonatal deaths and the Millennium
Development Goal 4
150
100
Global mortality per 1000 births
50
0
1960
1980
2000
2020
Year
Millennium Development Goal 4 can only be
achieved if neonatal deaths are addressed -
missing from current programmes
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The challenge
RCH II
IMR trends
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State-wise burden of neonatal deaths
Hr
UP
As
Pb
TN
Kn
WB
Gj
Or
MP
Mh
AP
Bi
Rj
Estimation based on data from National Human
Development Report 20017 SRS 2001
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MOST CHILD DEATHS ARE PREVENTABLE Universal
coverage with a few interventions can prevent
over 1.2 million deaths this year
Source Jones et al Lancet CS series
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MOST CHILD DEATHS ARE PREVENTABLE Universal
coverage with a few interventions can prevent
over 1.2 million deaths this year
Source Jones et al Lancet CS series
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New Born Child Health Key Strategies

• Increase coverage of skilled care at birth for
  newborns in conjunction with maternal care
• 2. Implement, by 2010, a newborn and child health
  package of preventive, promotive and curative
  interventions using a comprehensive IMNCI
  approach

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New Born Child Health Key Strategies under RCH
II/NRHM

• 3. Strengthen and augment existing services (care
  at birth/Essential New born /care, ARI and
  diarrhea control) in areas where IMNCI is yet to
  be implemented.
• 4. Implement the multi year strategic plan for
  the UIP (Universal Immunization Program)

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CHILD HEALTH INTERVENTIONS

• Essential new born Care
• Integrated management of neonatal and Child hood
  Illness
• Exclusive Breast Feeding and Timely introduction
  of complimentary Feeding
• Immunization

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CHILD HEALTH INTERVENTIONS

• Vitamin A and Iron and folic acid supplementation
• Early detection and management of ARI/ diarrhoea
  and other infections
• referral care
• pre service training

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CHILD HEALTH Interventions Essential New born
Care

• Initiation of early
• breast feeding.
• Rooming/ keeping
• baby warm
• Resuscitation.
• Infection prevention
• Immunization

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CHILD HEALTH Interventions- Breast Feeding

• Early Initiation
• Excusive feeding till 6 months
• Starting Complementary feeding at 6 months

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CHILD HEALTH Interventions - Diarrhoeal disease

• Increase ORS Use rate /addition of Zinc
• Prevention
• of diarrhea (Safe Water, Contd. feeding)
• Rational drug usage

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CHILD HEALTH Interventions - ARI Management

• Early recognition
• of fast breathing
• Cotrimoxazole administration for Pneumonia
• Rational drug usage

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CHILD HEALTH Interventions - Immunizations

• Complete Immunization schedule in first year
• Supplementation of
• Vitamin A and Iron

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CHILD HEALTH Interventions Integrated
Management of Neonatal and childhood Illness

• Appropriate care of
• sick new born
• and sick child.
• Recognition of
• Danger Signs
• Counseling
• on Breast Feeding
• and Nutrition

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CHILD HEALTH Interventions Referral / Facility
Care

• Care of Sick
• New born /Child
• Emergency Assessment /Care.
• Management of
• Malnutrition.
• Pilot in MP

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Interventions Home Based Care

• Care of Sick
• New born at Home
• Based on Gadchiroli Model.
• Pilot in UP, Bihar, Orissa,
• Rajasthan and MP

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Child health Indicators

• Infant Mortality Rate/Under five mortality Rate.
• of children visited within 24 hrs of and on 3rd
  and the 7th day of delivery by a trained
  provider.
• of children who were breast fed within 1 hr of
  delivery and exclusively for 6 months.
• of children fully immunized.

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Child health Indicators

• 6. of children with Anaemia and who received
  IFA syrup.
• 7. of children with ARI and of children with
  ARI who received antibiotic and were referred to
  health centre.
• 8. of children with diarrhoea who received ORS
  and were referred to health centre.
• 9. of children who have received Vit A all
  nine doses

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Methodology

• Analysis of NFHS I, II, III, DLHS III, MIS, on
  CH indicators
• Assessment of field visits to States.
• Visits to health facilities (District Hospitals,
  CHC/FRU, PHC, SC
• Meetings with health providers at State and
  district level
• Meetings with NGOs and other stakeholders.
• Meeting with beneficiaries and community

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• TRENDS IN CHILD HEALTH

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StatesEarly initiation of Breast Feeding
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Exclusive Breast Feeding

• All states show improvement except UP, Goa and AP
  
• 3 better performing StatesExclusive B-fd
  
• Jharkhand (49.7)
• Chhattisgarh (43.2)
• Orissa (43.1)
• Performance of other States
• Kerala ( 22 )
• T.N (23 )
• A.P. ( 33)
• Goa (28)
• Puducherry (26 )
• Bihar reported least exclusive breast fed
  children (12)

No state has achieved rate of 50
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Immunization indices are improving
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High drop out rates (gt15) remains critical
issue in Bihar, MP and UP
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Anaemia Is Widespread throughout India
Children age 6-59 months
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Training - Child health
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Home visits for New Born across several
districts

• 63 Home visits on day-1 of reported births
• 61 3 home visits in first 10 days

Implementation information available from limited
districts
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Initiatives in Pipeline

• F-IMNCI (IMNCI and Facility based care in the
  process of finalization)
• Newborn Health Care strategy on the anvil
• School Health Programme
• Pentavalent Vaccine

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Innovative Schemes

• District Child Health Co-ordinator (Rajasthan,
  MP, Orissa)
• ISO certification of District Hospitals. Standard
  Protocols for New Born and Sick New Born at
  District Hospitals (Gujarat)
• New Born Care Kits (2 Baby Mattresses 4 Baby
  Jackets 3 Baby Caps 3 pairs of Gloves 12 Baby
  Diapers and 8 Baby Blankets) (AP)
• Health information help line

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Way Forward

• Strengthen Care at birth (Essential Newborn care)
  at all facilities (logistics and capacity)
• Scale up IMNCI
• Training pace (In Service / Pre Service )
• Implementation ( in districts )
• Supportive supervision
• Reporting monitoring
• Accelerate facility based care for sick newborn
  and children with standard protocols
• Intensify BCC for Child Health feeding
  practices, ORT, ARI, newborn care practices
• Training of health providers in non-IMNCI
  districts on newborn care, ARI and Diarrhea