Accelerating Child Survival and Development in Gujarat and in India

1. Accelerating Child Survival and Development in Gujarat and in India Dr Genevieve Begkoyian, MD MPH Chief of Health, India Country Office Healthy Gujarat – Agenda for ActionMahatma Mandir, Gandhinagar, Gujarat 3 December, 2013

2.  India today • No case of polio in 33 months • 60 million new toilet users • 11.1 million more children in school • Food security bill passed • Nutrition missions formed • NMR declined by 9% in 2 years • And …. • Stunting decreased by 16% in Maharashtra since 2006 • U5MR reduction from 118 to 55 between 1990 and 2011 • IMR in Gujarat 10 points decline in last 3 years

3. Maternal Mortality in Gujarat • Current Interventions • SBA, BEmOC, CEmOC • VHND/ Mamta Diwas • Referral transport through EMRI 108 • Chiranjeevi Yojana • Janani Suraksha Yojana • Janani Shishu Suraksha Karyakram • Focus on Adolescent Health Goal Source: SRS 2007-09

4. Infant Mortality trends in Gujarat • > 50,000 deaths among under-ones annually • 70 % infant deaths during neonatal period Rural 45 Total 38 Goal 29 Urban 24 Source: Latest SRS reference -2012 by RGI

5. Causes of Under 5 Deaths : India Avoid preventable deaths Data Source : CHERG Estimates for Causes of Under 5 Deaths 2012, based on 2010

6. Success factor 1 • Leadership at the highest level to ensure priority to child health and development outcomes across sectors, with large investments

7. >7 millions children not imunized in India 69% of partially and un-immunized children in 6 states: Uttar Pradesh Bihar Madhya Pradesh, Rajasthan West Bengal Gujarat Data not available Below5 % 5 % - 10 % >10 % - 25% >25 % Source: CES 2009; Full immunization of children surveyed 12-23 months

8. Identification of High Risk Areas, India, February 2013 = 10 Migrant sites = 10 HR sites High risk areas in settled population Migrant sites ~ 166,000 HR areas in settled population ~ 256,000 Migrant sites

9. Full Immunization (%)-State wise coverage All India immunized children Reaching the 7 millions children un immunized Source: CES (2009)

10. Success factor 2 RESULTS BASED focusing on most deprived Reduction in neonatal mortality

11. Focusing together on those at highest risk: the Adolescent Inter departments and cross line ministries coordination • Adolescent • Out of school • Early marriage • Early pregnant • Anemia, Malnutrition • High risk Mother & child • Prematurity • Low birth weight • Post partum Hemorrhage Focus of QUALITY care including nutrition and hygiene practices Zero tolerance to maternal and newborn death

12. Success factor 3 Evidence based: facility based, outreach community based strategies

13. Newborn Stabilization Units Continuum of Care SNCU Continuum of care for new born survival IMNCI / HNBC / NBCC Community/PHC level CHCs at block level District Level

15. Success factor 4 Equity focused and targeted interventions maternal and newborn for most vulnerable Scale up interventions, as part of continuum of care (RMNCH+A)

16. Partnerships with Private sector Treatment seeking behavior in childhood diarrhea (CES-2009) Focused areas Partnership Professional bodies Accreditation Improving quality of care

17. India: Gaps in achieving optimal nutrition in children under two

18. Hygiene protocols for RMNCH +A Behavior change for healthy life sustainable practices • Facility to ensure • Availability of functional toilet and HWWS facilities • Availability of HW soap • Surface cleaning agents • Availability of clean water supply • Laundry facilities • Availability of disposal bin

19. …but the change is possible The change is happening…

20. THANK YOU