Child Heath- status and
Initiatives in Gujarat
Dr Siddharth Nirupam
Presentation outlineCurrent Status of Child Heath
Mortality trendsCauses of Child DeathChild Nutrition
Priority intervention (within continuum of care)Programme Thrust- Reaching the Unreached
Where are the unreached- mapping and HP areasWhy they are not reached- barrier identification and
action
Trend of Infant Mortality Rate (IMR)
in Gujarat54 53 52
5048
4441
3835
29
24
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2017
IMR
per
100
0 Li
ve B
irth
s
@ 1 per year i.e.
1.9%
@ 2 per year i.e. 2.8
& 4 % @ 4 per year i.e. 8.3 %
@ 3 per year i.e. 6.8 & 7.3 %
NRHM Chiranjeevi
108 NirogiBal
BalSakhaSource: SRS Infant Mortality Estimates
Causes of under- Five Death
Too Thin for Age Too Thin for Height
Normal %[Green]
Severe Under Weight %
(Red)
Moderate Under Weight
% [Yellow] Moderate Acute
Malnutrition (MAM) %Severe Acute
Malnutrition (SAM) %
44.6%
Underweight (%)
55.4%
28.3%
16.3% 5.8
%
12.9%18.
7%
Wasting (%)
Source:- NFHS- 3 (2005-06)
Child Nutrition Status - Gujarat
1. Improving new born care – Home and facility
2. Diarrhea and Pneumonia - Prevention & Management
3. Routine Immunization with equity focus
4. Child Nutrition- IYCF; Malnutrition management
Priority Interventions for Child Health
Gujarat’s Child Health Programme within Continuum of Care
Time Period
KPSY-1 KPSY-2
KPSY-3
3 levels of care- Family care, outreach, Facility
VHND – Mamta Abhiyan, e Mamta
JSSK, FRU
FBNCNSSK
IMNCI Plus
Ad
ole
sc
en
t
Chiranjeevi Yojana
JSY
RSBY Bal Sakha Ext. BalSak (Trbl Bloks)
MA
Follow up of LBW & SCNU Discharged
EMRI-108 Khilkhilat
N U T R I T I O N M I S S I O N
Evaluated Achievements of key Interventions across life stages- Gujarat
Data source: CES 2009;DLHS 3(%-National Average)
Newborn Care Continuum
Role of Private Sector - (Diarrhoea)
ORS Use RateCurative care & Private SectorCES -2009
Undernutrition in Gujarat
coverage of 10 proven interventions for its reduction
Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India***Coverage Evaluation Survey, UNICEF,2009BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition
The Goal 100%
%
Where are The unreached?
Reaching the Unreached for Child Health
41 48
27
Latest SRS reference -2009 by RGI
Goal 27
Death rates higher in rural but Urban poor death rates > urban averageIMR in ST > State average
IInfant Mortality trends- Rural Vs Urban
Immunization Status by Wealth Quintile, Gujarat
Coverage Evaluation Survey, 2009
DLHS-3
Disparity in Infant Feeding by District
3. CF: Timely Introduction
1. BF: Timely Initiation 2. Exclusive BF: 0-6 mo
IYCF: Composite Index (1+2+3)
Gujarat High Priority Districts (8)
HPD and Tribal districts
HPD but not Tribal districts
Why are they unreached?
Reaching the Unreached for Child Health
18
Six Coverage determinants- Tanahashi Model
Availability of drugs/suppliesAvailability of drugs/supplies
Availability of Human ResourcesAvailability of Human Resources
Geographical AccessGeographical Access
Utilization Utilization -first contact-first contact
Effective Coverage -qualityEffective Coverage -quality
Adequate Coverage Adequate Coverage -continuity-continuity
Immunization Coverage- where is the gap
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
Availability – critical inputs to health system
Adequate coverage- continuity
Utilisation – 1rst contact with services
Accessibility – physical access to services
Effective coverage- quality
Target Population
Accessibility – to human resources
Availability of Vaccines and Supplies (near 100%)
Availability of vaccinator (near 100%)
Functional Access to Mamta diwas (near 100%)
Initial Utilization (BCG coverage ( >95%- DLHRS 11)
Continuous (Measles coverage (79%)
Fully Immunized (69%)
Immunization Program- aim 100% coverage
Some Common Bottlenecks in Child Health Programming in IndiaLimited availability of Human ResourcesLow availability and access to Child Health
in some areas- e.g. UrbanLow Demand generation in some areas Low skill building- e.g. Facility Newborn
careTransport/ communication gaps in difficult
areasInadequate supervisionData Quality
Suggested Issues for Child Health ProgrammingUnreached Areas
Rural- Drilling down to at least taluka level for local barrier analysis and local solutions
Urban Poor- Mapping, infrastructure, service delivery, MISChild Malnutrition- Experiences from other countries-
IYCF communication; SAM management; MicronutrientsGram Sanjivini Samiti - Increasing community
participationEmergency Transport- number and type for difficult
areasStrengthen Supportive supervision for skills and quality Private sector- Evolving relationship
Thanks