Accelerating Child Survival and Development in Gujarat and in India

Dr Genevieve Begkoyian, MD MPHChief of Health,

India Country Office

Healthy Gujarat – Agenda for ActionMahatma Mandir, Gandhinagar, Gujarat3 December, 2013

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 2006U5MR reduction from 118 to 55 between 1990 and 2011IMR in Gujarat 10 points decline in last 3 years

389

202

172 160148

100

0

50

100

150

200

250

300

350

400

450

1989 1999-01 2001-03 2004-06 2007-09 2010-12 2015

Mat

erna

l Mor

talit

y Ra

tioMaternal Mortality in Gujarat

Source: SRS 2007-09

Goal Goal

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

0

20

40

60

80

100

120

140

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

Rural

Total

Urban

Total 38

Rural 45

Urban 24

Source: Latest SRS reference -2012 by RGI

Goal 29Goal 29

> 50,000 deaths among under-ones annually 70 % infant deaths during neonatal period > 50,000 deaths among under-ones annually 70 % infant deaths during neonatal period

Infant Mortality trends in Gujarat

Causes of Under 5 Deaths : India

Data Source : CHERG Estimates for Causes of Under 5 Deaths 2012, based on 2010

Avoid preventable deaths

Success factor 1

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

Data not available

Below 5 %

5 % - 10 %

>10 % - 25%

>25 %

>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

Source: CES 2009; Full immunization of children surveyed 12-23 months

~ 256,000 Migrant sites

Migrant sites High risk areas in settled population

~ 166,000 HR areas in settled population

= 10 Migrant sites = 10 HR sites

Identification of High Risk Areas, India, February 2013

Full Immunization (%)-State wise coverage

Source: CES (2009)

Reaching the 7 millions children un immunized

All India immunized children

Success factor 2

RESULTS BASED focusing on most deprivedReduction in neonatal mortality

Focusing together on those at highest risk: the Adolescent

• 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

Inter departments and cross line ministries coordination

Success factor 3

Evidence based:

facility based, outreachcommunity based strategies

Continuum of Care

SNCU

Newborn Stabilization

Units

District Level

IMNCI / HNBC/ NBCC

Community/PHC level

CHCs at block level

Continuum of care for new born survival

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)

Partnerships with Private sector

Treatment seeking behavior in childhood diarrhea (CES-2009) Focused areas

• Partnership • Professional bodies • Accreditation• Improving quality of care

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

Hygiene protocols for RMNCH +A

Behavior change for healthy life sustainable

practices

…but the change is possible

The change is happening…

THANK YOU