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
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