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Dr. Renu Srivastava MNCH Advisor (JHPIEGO-NIPI) Child health Division

Key Priority Interventions under child health programmes. Dr. Renu Srivastava MNCH Advisor (JHPIEGO-NIPI) Child health Division Ministry of Health & Family Welfare Government of India. Achievements. For the First Time. Maternal Mortality Ratio – MDG 5 achieved

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Dr. Renu Srivastava MNCH Advisor (JHPIEGO-NIPI) Child health Division

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  1. Key Priority Interventions under child health programmes Dr. Renu Srivastava MNCH Advisor (JHPIEGO-NIPI) Child health Division Ministry of Health & Family Welfare Government of India

  2. Achievements For the First Time • Maternal Mortality Ratio – MDG 5 achieved • India certified as ‘Polio-free’ by WHO in March 2014 and has since maintained the status • Maternal & Neonatal Tetanus (MNT)– ELIMINATED !! • India’s U5MR has equalled the global U5MR • India’s share among deaths is now proportionate to the share of births

  3. FOR WOMEN, STILLBIRTHS, NEWBORNS, THE TIME OF HIGHEST RISK IS THE SAME Outcome of1000 Live Births ~62% U5MR

  4. A Snapshot of Child Health in India • Children & Adolescent constitute > 40% of Population • 50% adolescents anemic, • 30 % undernourished, • 10-30% practicing risk behaviour • 7-8% adolescent Pregnancy • 50% deaths of newborn occur on the day of birth UP, Bihar, MP and Rajasthan account for 57% of total under-5 deaths Rural / Urban Gap Gender gap Huge inter& intra districts variations

  5. Why are children dying • Important reasons for neonatal mortality are prematurity (30%), Sepsis (18%), and Asphyxia (13%) • Diarrhea and pneumonia still contribute to 30% of under five child mortality • Under-nutrition is an underlying cause of deaths in 34% of under five child mortality • Vaccine preventable diseases and congenital anomalies are other reasons for child mortality and morbidity

  6. Progress of Key Interventions Across RMNCH+A Spectrum Additionally, more than 81 lakh children fully immunized under Mission Indradhanush Reduction in Average OOPE in Child Birth in public health from Rs 1162 to Rs 872

  7. NHM - Main Approaches Need Based Planning & Financing Communitize More money for health More health for money Improved Management Monitor Progress Health System Strengthening

  8. RMNCH+A STRATEGY Strategic Entitlements to Eliminate OOP expenses and incentives Prioritization of Aspirational districts Strategic actions for newborn survival Continuum of Care Life Cycle Approach INAP System Strengthening under NHM Convergence with other stakeholders

  9. SIX INTERVENTION PACKAGES INAP Across family and community level, outreach/Sub Centre level & at the facility Committed to single digit Neonatal mortality rate and stillbirth rate

  10. Objectives of National Health Policy2017 • achieve the highest possible level of good health and well-being, through a preventive and promotive health care orientation • achieve universal access to good quality health care services without anyone having to face financial hardship as a consequence. • proposes free drugs, diagnostics and emergency care services in all public hospitals.

  11. Strategic Interventions under Child Health Programme Birth Defects Surveillance Stillbirth Surveillance Child Death Review

  12. Ante natal care PMSMA antenatal checkups 16 million 25% HRPs identified –checkups in HPD facilities provide PMSMA services 13100 5300 volunteer doctors from private/ NGOs Proposed ECD call centre at district level to counsel the parents from the conception onwards

  13. Certification of Labour Rooms & Maternity OTs • Focus on Quality Improvement & Respectful Maternity Care (Labour Room Quality Improvement Initiative) GOI guideline for conducting USGs at FRU level around 20 weeks Early Childhood Development- Journey of the First 1000 Days

  14. Care starts from Labour Room

  15. Activities under Newborn Health

  16. Specific Actions Under Home Based Care for Newborns & Young Children Promote exclusive breastfeeding Add variety of food from family pot, booster vaccination Increase amount of CF, give feeds adequate in quality and quantity Initiate complimentary feeding (CF), introduce IFA syrup, ORS Increase frequency of CF and measles vaccine 12 months 15 months 9 months 6 months 3 months

  17. Malnutrition: A Silent emergency...

  18. Key Strategic Interventions Prioritization Mission Mode & Convergence Incentivisation of FLWs Conditional cash Transfer

  19. Activities to improve Child Nutrition Early initiation of BF (41.6%) and exclusive BF rates (54.9%) are low • Breastfeeding averts 13% of U5 Deaths • Complementary Feeding averts 5% deaths

  20. Anemia Mukt Bharat 6 v 6X6X6 strategy 6 6 institutional interventions mechanisms

  21. Activities to address Diarrhoea & Pneumonia Promotion of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) for early diagnosis and case management and F-IMNCI at facility level ORS Use Rate is 50.6% and Zinc use rate <25% Intensified Diarrhoea Control Fortnight (IDCF) observed during July-August, with the ultimate aim of ‘zero child deaths due to childhood diarrhoea’

  22. Child Screening & Early Intervention Services or RBSK Defects at birth: 17 lakh babies each year Diseases: dental caries in 50-60% school children, RHD: 1.5/1000 children Deficiencies:70% anaemic; 43% underweight Developmental delays & disabilities: 10% children An estimated 1.5 million babies born with a birth defect, account for 9.6% of all newborn deaths and 4% of under five mortality in India Under the RashtriyaBalSwasthyaKaryakram, systemic approach to early identification of 4Ds: Defects at birth, Deficiency, Diseases and Disability in children 0-18 years (270 million) Referral • Free of cost services including surgical interventions in District Early Intervention Centre or at pre-identified tertiary level institutions • Newborn screening birth – 6 weeks at public health facilities & through home visits by ASHAs • Screening of children at AWCs and in schools by Mobile Health Teams • Early Intervention Centre (DEIC) at District hospital for further assessment and act as a referral linkage to appropriate health facility Screening Management

  23. Universal Immunization Programme • Largest immunization programme in world • 30 million pregnant women and • 26 million newborns targeted annually • 9 million sessions held annually • 27,000+ cold chain points • 12 Vaccine Preventable Diseases covered • Mission Indradhanush- Over 33.7 million children and 8.6 million pregnant women immunized PolioHep- B | Measles | H- Influenza- B | Tuberculosis | Diptheria | Pertussis | Tetanus | Japanese Encephalitis | Rotavirus diarrhea | Pneumonia | Rubella

  24. Everybody has a role • Forging effective Public Private Partnership • Aligning of multiple stakeholders for meaningful actions • Dissemination of all National Guidelines through the extensive national network of district level offices • Active Participation in the capacity building exercises • Use of District level champions in mentoring and supportive supervision exercises • Innovative service delivery mechanisms to improve access to quality care including low cost services

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