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Child Health in India

Child Health in India. By Vikash Moderator: Dr. Chetna Maliye. Introduction & History: History of Child health services in India. Major Milestones for child health in India. Child Health Statistics: Indicators of Survival Mortality Statistics:

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Child Health in India

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  1. Child Health in India By Vikash Moderator: Dr. Chetna Maliye

  2. Introduction & History: • History of Child health services in India. • Major Milestones for child health in India. • Child Health Statistics: • Indicators of Survival • Mortality Statistics: • National Programmes for child Health in India. • Future Strategies.

  3. The story of India is one of growth, gains and gaps. With an economy that is going from strength to strength, benefiting from the demographic dividend of a young and growing workforce, this largest democracy of the world is also home to the largest number of children in the world. With this growth come real gains for India’s children and women. The situation of Children in India - A Profile, UNICEF, India, May 2011

  4. Introduction & History: • India: Country of Great Contrast & Complexity. • Not only Rich vs. Poor. • Disparities b/w : Geographic regions, Social groups, Income levels and b/w Sexes.

  5. Introduction: • The First Five Year Plan (1951-56): Maternal and child health Services in India. • First country in the world to launch family planning programme. • Till 1977 Major health activity was family planning. • Family welfare programme included Maternal and Child Health an integral part. • Vision : Reduction in birth rate has a direct relationship with reduction in infant and child mortality.

  6. Introduction Cont….. • National Health Policy 1983: • Envisioned significant reduction in IMR, NMR & U5MR by 2000. • 1985: • Universal Immunization Programme against six preventable diseases introduced in a phased manner which covered whole India by 1990. • 2000: Millennium Development Goal 4 • 2000: National Population Policy. • 2002: National Health Policy.

  7. MILES STONE IN MCH CARE • 1946 - Bhore Committee Recommendation on Comprehensive & Integrated Health Care • 1951 –Family Planning Programme • 1956 – MCH Centers Become Integral Part Of PHC. • 1961 - Department Of Family Planning Created. • 1971 – MTP Act. • 1974 – Family Planning Services Incorporated MCH Care • 1975 – ICDS Launched • 1977 – Renaming Family Planning To Family Welfare

  8. 1978 – Expanded Programme on Immunization. • 1983 – National Health Policy envisioned significant reduction in IMR, NMR & U5MR • 1985 – Universal Immunization Programme • 1990 - The ARI Control Programme was started. • 1992 – Child Survival& Safe Motherhood Programme • 1996 – Target Free Approach • 1997 – Reproductive & Child Health Programme Phase-1 (15.10. 1997) • 2000: MDG 4 • 2000: National Population Policy • 2002: National Health Policy • 2005 – RCH Programme Phase-2 (01-04-2005) • 2005 – National Rural Health Mission.

  9. Child Health: Vital Statistics • Indicators of Child Survival: • Birth Weight. • Breast Feeding • Immunization coverage. • Child Morbidities Statistics. • Nutritional Status • Mortality Statistics: • Neonatal Mortality • Infant Mortality • Under 5 Mortality

  10. Indicators of Child Survival: • Birth Weight: Figure 1: proportion of LBW National Family Health survey – 3, IIPS, Mumbai, 2006.

  11. Breast feeding Practices: • Initiation of Breast Feeding: Figure 2:Proportion of ever Breast fed and initiation of breast feeding (NFHS -3)

  12. Pre-lacteal Feeding: Figure – 3: types of prelacteal feeding (NFHS -3)

  13. Figure- 4: Infant and Young children Feeding

  14. Immunization Coverage: Figure- 5: Immunization coverage

  15. Figure -6: Immunization status wealth quintile (CES-2009)

  16. Figure 7: Immunization status state wise (CES -2009)

  17. Child Morbidity Statistics: Figure -8: ARI, Fever and Diarrhea cases

  18. Nutritional Status:Figure – 9: Percentages of underweight, wasted and Stunted Children

  19. Figure-10: Proportion of Children Underweight, stunted or wasted according to age.

  20. Recent: Hunger and Malnutrition (HUNGaMA)Report • By the Naandi Foundation. Recently released by the Prime Minister. • Sample Size: Survey of more than one lakh children across six States. • 112 rural districts (included 100 Focused) (Bihar, Jharkhand, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh). • Key Findings: • 42% of under-five children severely or moderately underweight. Decreased from 53 to 42% in last 7 years. • 59% of underweight children moderate to severe stunting • About half of stunted are severely stunted. • About half of all children are underweight or stunted by two years.

  21. Prevalence of malnutrition is significantly higher among children from low-income families, Muslim or SC/ST • Birth weight is an important risk-factor for child malnutrition. The prevalence of underweight among LBW is 50%. • Among Birth weight above 2.5 kg is 34%. • Nutrition advantage girls have over boys in the first months of life gets reversed over time as they grow older.

  22. Figure-11: Coverage along the Continuum of care (CES-2009)

  23. Mortality Statistics: Figure- 12A & B: Trends of Neonatal Mortality (Source -8)

  24. Figure- 13A & B: Trends of Infant Mortality Rate

  25. Figure -14: Infant Mortality rate by demographic criteria

  26. Figure -15A & B: Trend of Under 5 Mortality

  27. Child Health Programmes India:

  28. National Family Planning Programme: • Launched in 1951. • Emphasised on Population control Measures. • Specific objective : • "Reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the National economy” • Approaches: Before 1961 census: • Clinical approaches: Facilities for provision of services were created. After 1961: • Extension and Education Approach: 1969: To reduce birth rate from 35 per thousand to 32 per thousand by the end of 4th Five year plan.

  29. V plan (1974-79): • Birth rate to 30 per thousand by the end. • Integration of family planning services with those of Health, Maternal and Child Health (MCH) and Nutrition.  • 1975-77: • Emergency declared in the country and forceful and coercive measures used for sterilization. • 1977 – Programme Renamed as Family Welfare Programme: • Maternal & Child Health Became one of the Components. There after the programme continually ran as voluntary programme.

  30. DIARRHEAL DISEASE CONTROL PROGRAMME: • Started in 1978. • Objective: To prevent death due to dehydration caused by diarrheal diseases among children less than 5 years of age. • Oral Rehydration Therapy (ORT) program was started in 1986-1987. • Later on Diarrheal Disease control is part of child health strategies all along.

  31. Universal Immunization Programme: • 1975: WHO launched “ Expanded Programme on Immunization. (EPI)” • 1978: Alma Atta conference ; Immunization recognized as a strategy for “Health For All”. • Government of India launched EPI in 1978. • 1985: UNICEF pledged for “Universal Child Immunization” • 1985-86 : Govt. of India launched “Universal Immunization Programme”. • Objective: • To cover at least 85 percent of all infants against the six vaccine preventable diseases by 1990. • To achieve self-sufficiency in vaccine production and the manufacture of cold-chain equipment • UIP become a part of the Child Survival and Safe Motherhood (CSSM) Programme in 1992 and Reproductive and Child Health (RCH) Programme in 1997.

  32. ARI control Programme: • Started in 1990. • Sought to introduce scientific protocols for case management of pneumonia with Co- trimoxazole. • Since 1992 the Programme implemented as part of CSSM and later with RCH. • Under RCH-II : Implemented in an integrated way with other child health interventions. • IMNCI, ARI is managed according to IMNCI Guidlines.

  33. Child Survival and safe Motherhood Programme: • Launched in 1992. • Objectives: • Increase child survival. • Promote safe motherhood, including establishing first referral units (FRUs) for secondary-level care of mothers and their newborn. • Strengthen the delivery of services by improving institutional capability. • Results: • The overall objectives were partially met. • Discontinuation of practice of setting fertility reduction targets and increased emphasis on MCH. • Not only were ongoing MCH activities sustained, but the range of services increased.

  34. Reproductive and Child Health Programme: • 1997: RCH Programme launched. • Integration of Child Survival and Safe Motherhood (CSSM) Programme with other reproductive and child health (RCH) services. • Aims & Objectives: Overall aim is to reduce infant, child and maternal mortality, Specific objectives: • Improve management performance by "participatory planning approach“ and institutional strengthening for timely, coordinated utilization of resources; • Improve quality, coverage and effectiveness of existing FW services. • Expand the scope and content of existing FW services to include more elements. • Selected disadvantaged districts and cities, increase access by strengthening FW infrastructure while improving its quality.

  35. Outcome regarding Child Health Components: RCH Programme

  36. 2000: Millennium Development Goals: • GOAL 4: Reduce Child Mortality • Target:  • 4 a: Reduce by two thirds, between 1990 and 2015, the mortality rate of children under five. • Under-five mortality rate. • Infant mortality rate. • Proportion of 1 year-old children immunised against measles • National Population Policy 2000: Reduce IMR to 30/1000 live births • National Health Policy 2002: Reduce IMR to 30/1000 by the year 2010.

  37. Reproductive and Child Health Programme 2: • launched 1st April, 2005. • Objective: • Reducing total fertility rate, infant mortality rate and maternal mortality rate. • Child Health Interventions of RCH 2: • Guiding principles: • Evidence-based interventions. • Integrated approach. • Equity-driven implementation and monitoring. • Rational mix of family-centered (home based), population centered (outreach) and individual-centered (clinical) interventions. • Decentralized priority setting and phasing at the state and district levels. • Participation from private sector

  38. The objectives of the newborn and child health strategy: • Increase coverage of skilled care at birth. • Implement, by 2010, a newborn and child health package of preventive, promotive and curative interventions using comprehensive IMNCI approach at: • Sub-centres. • Primary health centers. • Community health centers. • First referral units • At the household level in rural and poor peri urban settings in at least 125 districts (through AWWs / LVs / ASHAs) • Implement the medium-term strategic plan for the UIP (Universal Immunization Program). • Strengthen and augment existing services in areas where IMNCI is yet to be implemented.

  39. Newborn Intervention: • Scenario-based approach on prioritizing newborn health strategies: • Key Issues in Managing Sick Newborn and children: • Promote early recognition of sickness, including severe malnutrition • Promote healthy household practices and avoid harmful practices • Promote early care seeking • Ensure access at the community level to a provider who can manage/refer sick neonates/and children • Promote community/home-based care of mild to moderate illnesses that require no referral

  40. Promote appropriate referral and ensure safe transport of neonates/children with severe disease • Make ORS more widely available, close to the source of demand • Involve AWWs as the first contact provider for sick neonates/children • Enable AWWs to treat children with diarrhoea and ARI with ORS and cotrimoxazole, respectively • Enable ANMs to use gentamicin to treat neonatal sepsis • Ensure functional PHCs, CHCs and FRUs to cater to the care of sick • neonates/children • Ensure care of sick neonates/children of BPL families in private facilities  Breastfeeding and complementary feeding: Promotion of Exclusive Breast Feeding and appropriate Complementary feeding.

  41. IMNCI ‘Plus’ •  Need to add the inpatient care component for facilities. • IMNCI package would still not cover the vital care of the neonates at birth in home and facility settings. • IMNCI approach includes only counselling for immunization. • The implementation of immunization in India cannot be adequately done by the IMNCI contacts alone. Therefore, a comprehensive immunization plan will be required. • ‘The IMNCI Plus’ to combine the wider, comprehensive range of interlinked interventions that form the newborn and child health component of the RCH Phase II program.

  42. Navjaat Shishu Suraksha Karyakram: • High Neonatal Mortality Rate despite substantial reduction in childhood and infant mortality • Nearly two-thirds infant deaths each year occur within the first four weeks of life, and about two-thirds of those occur within the first week. • A new programme on Basic Newborn Care and Resuscitation. • Training course of 2 Days on: • Basic newborn resuscitation -1Day. • Basic newborn care-1Day. • Medical officers, Nurses & ANMs: responsible for conducting deliveries and managing newborn babies • Based at health centres (CHCs/FRUs/24x7 PHCs) and small hospitals (not referral hospitals)

  43. Child Health Strategy Under RCH 2. ASHA /HW Trained Person at Institutional IPHS / Capacity Building Of Staff

  44. Key Strategies Under RCH 2: • Skilled care at birth • IMNCI • Training for IMNCI • Health System Issues: Strengthening facilities for care of newborn infants and children CHCs and FRUs will be strengthened. • Ensuring referral of sick neonates and children • Permitting ANMs and AWWs to administer selected antibiotics • Other health system issues Strengthening of health infrastructure Uninterrupted availability of drugs and supplies High quality supervision and monitoring Ownership of the state and district level program managers • Efficiency of the administrative/ financial system

  45. Where We stand Now?

  46. Future Strategies: • Child Health Strategies for 2011 – 15: MOHFW, GOI. • STRATEGIC APPROACH-1: • Expand household and community care of newborns and children: • Expand role of community health workers on community based care of newborns and children: • Set up sub-center clinics on fixed time to ensure ambulatory management of sick newborns and children. • Design and Implement a behavior change communication (BCC) plan for newborn and child health and nutrition. • Expand coverage of VHNDs and basket of services for newborn and child health. • Orient RMPs & AYUSH practitioners on detection and management of childhood illnesses and growth promotion. • Strengthen community based nutritional interventions.

  47. STRATEGIC APPROACH-2: • Improve facility based care of newborns and children • Prepare and implement facility-specific plans for improving quality of care for newborns and children as per the revised Indian Public health Standards (IPHS). • Build capacity of health providers. • Strengthen referral of newborns. • Equip health facilities to support 48-hr stay of mother-newborns. • Engage private sector facilities for management of sick newborns and children. • Integrate newborn and child healthcare in social insurance schemes. • Develop surveillance sites for monitoring of Perinatal and neonatal mortality.

  48. STRATEGIC APPROACH-3: • Strengthen care of girls and women across the life-cycle for improved newborn and child health. • Improve healthcare and nutrition of adolescent girls and young women. • Promote spacing of 3 years between two childbirths. • Improve quality of skilled care at birth and expand post-partum care. • STRATEGIC APPROACH – 4: Build linkages to address emerging threats to child health (urbanization and children with special needs) • Improve access and quality of newborn and childcare for urban poor. • Expand the scope and focus of NCD programmes to include child health concerns. • Address the special needs of children with congenital heart diseases, congenital syphilis, Thalassemia, Hemophilia, Rheumatic heart disease and disability.

  49. Enabling actions: • Ensure adequate number and skilled human resources: • Multi-skilling of MOs for newborn and child health • Engaging AYUSH doctors in newborn and child health: • Empowering nurses for newborn and child health at facilities: • Explore introduction of nursing aides for newborn and child care in facilities • Building skills and capacities of health providers for newborn and child health: • Ensure adequate supplies and equipment: • Improve planning, management, support and oversight mechanism: • Establish a strong operations research programme • Promote partnerships for child health • Linkages and Convergence: • Linkages with other health programmes • Linkages with other sectors

  50. Janani ShishuSurakshaKaryakram • Launched on 1st June 2011.

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