E N D
2. Contents NMR in Orissa-Status
Major Causes
State Child Health Policy
Interventions
Challenges
3. Target 4a: Reduce by two thirds the mortality
rate among children under five
Enhancing Neonatal survival is essential if MDG- 4 is to
be reached.
4. Where to go
.
IMR from 71 to 50 / 1000 live births by 2012 (Source:-SRS 2008)
NMR from 46 to 35/ 1000 live births by 2012
5. INFANT MORTALITY TRENDS IN ORISSA AND INDIA
6. Causes of Neonatal deaths
7. Prematurity Causes
Malaria Burden in the state is high (Emergence of Chloroquine resistant malaria)
Anaemia: Prevalence ranges from 53.4%(Others) to 73.8% (ST) amongst different social groups
100 IFA consumption- ranges from
27% in SC to 37% in other social groups
Malnutrition & inadequate rest
8. Sepsis & Pneumonia Causes
Poor availability of Skilled attendant at birth in case of home delivery
Lack of Post Natal Care
Non initiation of early & exclusive breast feeding
Infections of Umbilical Cord & Skin
Cultural practices like bathing, pre lacteal feeds, throwing away colostrum etc
Lack of identification of critical signs & referral
9. Birth Asphyxia Untrained birth attendance
3 Delays- Delay in decision taking at household level, delay in reaching the facilities, delay in getting services
Lack of facilities at except 24X7 & FRUs
10. Tetanus Poor antenatal registration & check up
Mothers with at least 3 ANC(Over all -62%)
SC-59 % ST-46%
Two TT (Overall- 83%)
ST- 73% SC- 88%
Source NFHS -3 (2005-06)
11. Challenges - general Geographical inaccessibility of tribal populations affects coverage
Illiteracy, poverty, migration, inherent traditional customs influence health seeking behaviour in spite of service provisions
Vacancies of the service providers especially in hard to reach areas and backward districts
Gaps in socio cultural perspectives between service provider and beneficiaries
12. Strategies 1.Improved preventive management of malaria amongst pregnant women- LLIN
2.Implementation of IMNCI for improved case management of newborn at household level
3.SBA at delivery with enhanced institutional delivery to improve early neonatal survival through better neonatal resuscitation.
4. Establishment of facility based special newborn care unit networks: in block, sub division & district levels with referral chain SNCU- I , II ,NBC
5. Enhanced dedicated transportation availability
14. Prematurity-Implementational Challenges Intervention for Malaria Control
Provision of LLIN to Pregnant Women (proposed)
Early diagnosis & treatment; ASHA trained for BS collection, RDK testing ,referral & treatment
Challenges
Procurement of bed net delay
Usage of bed net Cultural & social issues
Hand holding support to ASHA for use of RDK
Rational distribution of RDK & monitoring
Inaccessibility & late arrival at health facilities
contd..
15.
Attempts to address Challenges
LLIN provided during 1st ANC after counselling
Supply of LLIN through GKS
Continued Counselling for use at VHND
RDK supplied & replenished at VHND
Awareness created for use of SC untied fund for referral of complicated malaria cases
16. Prematurity-Implementational Challenges Intervention for Anaemia & Malnutrition
Adolescent Anaemia programme for in school(through Teacher) & out of School girls(through AWW) -Weekly Observed Iron supplementation
Mamta Divas -Hb testing & monitoring by ANM, referral of severely anaemic Pregnant women using untied fund, Counseling for IFA & appropriate food intake
Challenges
Ensuring Compliances of IFA consumption PW & Out of school girls
Attempts to address Challenges
Linking with self help groups for Compliances of IFA consumption & nutritional counseling
17. Sepsis & Pneumonia(26%)-Implementational Challenges Interventions
IMNCI
SNCU
PNC Home visit & YASHODA at facilities
Challenges
Ensuring Quality of training- Availability of Alopathic doctors for imparting training
Regular supply of drugs & logistics
Handholding of trained IMNCI Worker
Constraint in attending hospital if referred
Scaling of facility based New born care- procurement & maintenance, Clinical man power,
execution of civil work contd...
18. Sepsis & Pneumonia(26%)-Implementational Challenges Recent attempts to address Challenges
Involving AYUSH Doctors to impart training
Equipment Maintenance Unit established
Funds allocated for sector level support supervision
Baby-kits for Institutional deliveries
19. Birth Asphyxia- Implementational Challenges Interventions
Promotion of Institutional Deliveries
SBA Training
Provision of DDK
Challenges
Infrastructure support to cater to increased load of Institutional deliveries
Unavailability of adequate skilled manpower-Anaesthesia & EmOC
Scaling up of SBA training sites Eligibility of institution for conducting training, residential accommodation within hospital premises, ensuring quality of training
Recent attempts to address Challenges
Annual grant for development of civil infra to FRU & 24 X7 hospitals on priority basis
Short term Anaesthesia & EmOC training on going
Service package for institutional delivery Birth registration, Counselling for Early initiation of breast feeding, BCG, Zero dose polio, JSY cheque, Mother & baby kit, 48 hour Institutional stay- Diet to attendant
Provision of DDK during 3rd ANC at VHND
20. Equity Lens Poverty among STs ranges from 67 to 82% across all regions of state.
Mothers with at least 3 ANC (over all 62%)
Two or more TT over all 83% , ST-73%
Stunting among STs is 57% , SCs is 50% & wasting is 28% (ST)
Full Immunization coverage is 30% among ST
IMR among STs is 79 & U5 MR is 136
21. Challenges in general
Challenges
Referral Transportation
Infrastructure support to cater the increased load of Institutional deliveries
48 hrs institutional stay
Unavailability of adequate skilled manpower-Anaesthesia & EmOC
22. Response Strengthening referral linkages :
Janani Express : One in each block
169 Ambulances provided : Rationalized provision (areas with high mortality and inaccessible institutions given priority)
191Mobile Health Units deployed in difficult pockets- ANMs in MHU are giving thrust on ANC and PNC
Sensitization of ANM, PRI members & representatives of GKS Increased utilisation of untied fund
23. Response Focus on civil infra of FRU & 24 X7 hospitals on priority basis
Outsourced engagement of Yosadha services at DHH
SHG Federation
Short term Anaesthesia & EmOC training on going
24. Response FBNC initiatives :
7 SNCU-II are functional
Another 13 SNCU-II-to be functional by Sept09
28 SNCU-I are functional
80 SNCU-I - to be functional by Mach10
185 New born corners functional in 24X7 institutions
150 New born corners - to be functional by March10