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CHILD HEALTH STRATEGY RCH II/NRHM

CHILD HEALTH STRATEGY RCH II/NRHM. National goals & MDG context. Perceptible decline in U5MR (Needs acceleration to >7 points to achieve NRHM goals) Slow decline in IMR Slower decline in the neonatal mortality. NFHS. Neonatal Mortality Rate. 1980-1990. 25%. 1991-2000. 15%.

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CHILD HEALTH STRATEGY RCH II/NRHM

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  1. CHILD HEALTH STRATEGYRCH II/NRHM

  2. National goals & MDG context

  3. Perceptible decline in U5MR (Needs acceleration to >7 points to achieve NRHM goals) Slow decline in IMR Slower decline in the neonatal mortality NFHS

  4. Neonatal Mortality Rate 1980-1990 25% 1991-2000 15% Source: SRS data

  5. When do neonates die die? About half of child deaths occur in the neonatal period (ICMR Study 2003)

  6. Under-5 mortality rate Early neonatal mortality Late neonatal mortality Target for MDG-4 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

  7. 90 80 80 79 80 74 74 74 72 71 70 70 68 70 66 64 63 60 60 55 58 Present 48 50 Desired trend trend IMR per 1000 live births for MDG 40 Desired trend for NPP goal 30 NPP Goal MDG Expectation 20 10 0 1990 1992 1994 1996 1998 2000 2002 2005 2010 2015 The challenge RCH II IMR trends`

  8. State-wise burden of neonatal deaths Hr As Pb UP TN Kn WB Gj Or MP Mh AP Bi Rj Estimation based on data from National Human Development Report 20017 & SRS 2001

  9. 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

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. CHILD HEALTH Interventions Essential New born Care • Initiation of early • breast feeding. • Rooming/ keeping • baby warm • Resuscitation. • Infection prevention • Immunization

  16. CHILD HEALTH Interventions- Breast Feeding • Early Initiation • Excusive feeding till 6 months • Starting Complementary feeding at 6 months

  17. CHILD HEALTH Interventions - Diarrhoeal disease • Increase ORS Use rate /addition of Zinc • Prevention • of diarrhea (Safe Water, Contd. feeding) • Rational drug usage

  18. CHILD HEALTH Interventions - ARI Management • Early recognition • of fast breathing • Cotrimoxazole administration for Pneumonia • Rational drug usage

  19. CHILD HEALTH Interventions - Immunizations • Complete Immunization schedule in first year • Supplementation of • Vitamin A and Iron

  20. 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

  21. CHILD HEALTH Interventions – Referral / Facility Care • Care of Sick • New born /Child • Emergency Assessment /Care. • Management of • Malnutrition. • Pilot in MP

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

  23. 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.

  24. 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

  25. 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 NGO’s and other stakeholders. • Meeting with beneficiaries and community

  26. TRENDS IN CHILD HEALTH

  27. States:Early initiation of Breast Feeding

  28. Exclusive Breast Feeding • All states show improvement exceptUP, 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%

  29. Immunization indices are improving

  30. High drop out rates (>15%) remains critical issue in Bihar, MP and UP

  31. Training - Child health

  32. 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

  33. 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

  34. 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

  35. 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

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