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Child Heath- status and Initiatives in Gujarat

Child Heath- status and Initiatives in Gujarat. Dr Siddharth Nirupam. Presentation outline. Current Status of Child Heath Mortality trends Causes of Child Death Child Nutrition Priority intervention (within continuum of care) Programme Thrust- Reaching the Unreached

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Child Heath- status and Initiatives in Gujarat

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  1. Child Heath- status and Initiatives in Gujarat Dr Siddharth Nirupam

  2. Presentation outline • Current Status of Child Heath • Mortality trends • Causes of Child Death • Child Nutrition • Priority intervention (within continuum of care) • Programme Thrust- Reaching the Unreached • Where are the unreached- mapping and HP areas • Why they are not reached- barrier identification and action

  3. Trend of Infant Mortality Rate (IMR) in Gujarat Source: SRS Infant Mortality Estimates

  4. Causes of under- Five Death

  5. Child Nutrition Status - Gujarat Source:- NFHS- 3 (2005-06) Too Thin for Age Too Thin for Height 55.4% Normal % [Green] 44.6% 28.3% Moderate Under Weight % [Yellow] Moderate Acute Malnutrition (MAM) % 18.7% 12.9% 16.3% Severe Under Weight % (Red) 5.8% Severe Acute Malnutrition (SAM) % Underweight (%) Wasting (%)

  6. Priority Interventions for Child Health Improving new born care – Home and facility Diarrhea and Pneumonia - Prevention & Management Routine Immunization with equity focus Child Nutrition- IYCF; Malnutrition management

  7. Gujarat’s Child Health Programme within Continuum of Care Time Period VHND – Mamta Abhiyan, e Mamta JSSK, FRU 3 levels of care- Family care, outreach, Facility IMNCI Plus N U T R I T I O N M I S S I O N Adolescent NSSK FBNC Follow up of LBW & SCNU Discharged KPSY-1 JSY KPSY-2 MA KPSY-3 RSBY Bal Sakha Ext. BalSak (Trbl Bloks) Chiranjeevi Yojana EMRI-108 Khilkhilat

  8. Evaluated Achievements of key Interventions across life stages- Gujarat Adolescence Pre-preg Pregnancy Delivery Postnatal Neonatal Infancy Data source: CES 2009;DLHS 3 (%-National Average)

  9. Newborn Care Continuum

  10. Role of Private Sector - (Diarrhoea) ORS Use Rate Curative care & Private Sector CES -2009

  11. Undernutrition in Gujarat coverage of 10 proven interventions for its reduction The Goal  100% % Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India ***Coverage Evaluation Survey, UNICEF,2009 BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition

  12. Reaching the Unreached for Child Health Where are The unreached?

  13. IInfantMortality trends- Rural Vs Urban Death rates higher in rural but Urban poor death rates > urban average IMR in ST > State average 48 41 27 Goal 27 Latest SRS reference -2009 by RGI

  14. Immunization Status by Wealth Quintile, Gujarat Coverage Evaluation Survey, 2009

  15. Disparity in Infant Feeding by District 1. BF: Timely Initiation 2. Exclusive BF: 0-6 mo 3. CF: Timely Introduction IYCF: Composite Index (1+2+3) DLHS-3

  16. Gujarat High Priority Districts (8) HPD and Tribal districts HPD but not Tribal districts

  17. Reaching the Unreached for Child Health Why are they unreached?

  18. Six Coverage determinants- Tanahashi Model Effective Coverage -quality Adequate Coverage -continuity Utilization -first contact Geographical Access Availability of Human Resources Availability of drugs/supplies

  19. Immunization Coverage- where is the gap Fully Immunized (69%) Effective coverage- quality Adequate coverage- continuity Continuous (Measles coverage (79%) Utilisation – 1rst contact with services Initial Utilization (BCG coverage ( >95%- DLHRS 11) Accessibility – physical access to services Functional Access to Mamtadiwas (near 100%) Accessibility – to human resources Availability of vaccinator (near 100%) Availability – critical inputs to health system Availability of Vaccines and Supplies (near 100%) Target Population Immunization Program- aim 100% coverage From Tanahashi T. Bulletin of the World Health Organization, 1978, 56 (2) http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf

  20. Some Common Bottlenecks in Child Health Programming in India • Limited availability of Human Resources • Low availability and access to Child Health in some areas- e.g. Urban • Low Demand generation in some areas • Low skill building- e.g. Facility Newborn care • Transport/ communication gaps in difficult areas • Inadequate supervision • Data Quality

  21. Suggested Issues for Child Health Programming • Unreached Areas • Rural- Drilling down to at least taluka level for local barrier analysis and local solutions • Urban Poor- Mapping, infrastructure, service delivery, MIS • Child Malnutrition- Experiences from other countries- • IYCF communication; SAM management; Micronutrients • Gram Sanjivini Samiti - Increasing community participation • Emergency Transport- number and type for difficult areas • Strengthen Supportive supervision for skills and quality • Private sector- Evolving relationship

  22. Thanks

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