Transcript India Country Presentation_Regional CH Meeting_Kathmandu
Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011
PROGRESS IN IMPLEMENTION OF CHILD HEALTH PROGRAMS
INDIA
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Trends of U5MR & IMR from 1990 -2009
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Total Under-five deaths: 1,696,000
120 118 100 97
Total Infant deaths: deaths: 1,305,000 Total Neonatal 875,000
80 60 40 80 74 85 68 77 58 64 50 Acceleration Required 39 27 20 0 1985 1990 1995
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2000 2005 2010 2015 2020 3 IMR R U5M
Infant Mortality Rate: Status in 2009
Only two large states have met the NRHM goal of IMR < 30, while two others are close to achieving it.
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Causes of under-five deaths in India: 2010
Malnutrition 34% 5 | India | Regional CH Meeting | Kathmandu | 15 Nov 2011
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State wise Change in IMR and NMR 2005 - 2009
In many of the larger states, there is decline in IMR but neonatal mortality mostly remains unchanged.
15 13 11 9 7 5 3 1 -1 -3 -5 10 10 8 9 7 9 Absolute change (decline) in NMR 5 5 4 9 4 2 3 9 3 8 3 6 2 9 2 8 2 6 Absolute change (decline) in IMR 2 2 1 9 1 5 0 10 0 9 0 7 0 6 -1 5 -3 4 6
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Undernutrition in India
50 45 40 35 30 25 20 15 10 5 0 48 42.5
Stunted Undernourished 7 | India |
Source: NFHS 3, 2005-06
| 15 Nov 2011 19.8
Nearly 8 million children with Severe Acute Malnutrition
< - 3SD 6.4
Wasted
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IMNCI Implementation
IMNCI implementation started (If yes, year) Newborn Added (If yes, year) 2002 2002 Number and Proportion of districts implementing IMNCI Number and proportion of Health Providers trained (districts included in state PIPs till Dec 2010 Proportion of districts (out of IMNCI districts) with
50%
or more health providers trained IMNCI supervisory checklists introduced Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month Data not available during previous year 433/640 68% (Jun 2011) 59% 155/326 47.5% (Mar 2011) No Proportion of districts (out of IMNCI districts) covered with Follow-up IMNCI training Data not available
Status of IMNCI Implementation, June 2011
• Launched in 2002-03 • Implemented in 433 districts (June 2011)
9 | India | Regional CH Meeting | Kathmandu | 15 Nov 2011 Data for 14 States
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IMNCI Implementation
IMNCI implementation review conducted IMNCI Health Facility Survey conducted Proportion of first-level health facilities with at least one health worker who cares for children trained in IMNCI
Pre-Service IMCI teaching/training:
Number and proportion of Medical Schools teaching IMNCI Number and proportion of Nursing Schools teaching IMNCI
ICATT
scale) introduced (If yes, year and Sub-national review conducted in Gujarat, Rajasthan and Karnataka Data not available Medical colleges in several states (approx 1/3 rd of medical colleges) Training introduced in nursing and ANM schools in Orissa and Rajasthan. F-IMNCI package on ICATT platform being developed
IMCI Implementation
Key factors that helped scaling up
• Network of teaching and training institutes • Enhanced opportunities under National Rural Health Mission – Increased availability of finances – Increased human resources (includes availability of ASHA)
Key challenges to scaling up:
• Coverage and Quality of basic and follow-up IMNCI trainings • Convergence with ICDS and within health system • Lack of adequate Supportive supervision • Lack of sustained supplies of drugs and logistics • Role clarity- AWW /ASHA • Sustained implementation • Quality monitoring and Review of the program
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CHW approach for care of newborns and children
• Home-based newborn Care and Sick Child Package – A training package developed for ASHA (Community Health Worker) – Module 6 & 7 cover Newborn and Child Health 1.
2.
3.
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6.
Module 6 Care of the baby at time of delivery Schedule of Home Visits Examining the Newborn at Birth Breastfeeding Keeping the Newborn Warm Management of fever in newborn Module 7 1. High Risk Assessment 2. Management of Low Birth Weight/Pre-Term Babies 3. Breastfeeding Low Birth Weight/Pre-Term babies 4. Neonatal Sepsis: Diagnosis and Management 12
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CHW approach for care of newborns and children
Home Based New Born Care: Training of ASHAs - Module 6: In 9 states , 17,200 ASHAs trained; In 10 states TOT done - Module 7: not rolled out yet in any state
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Essential New born Care
36,000 providers trained in NSSK against a • target of 2.75 lakhs 6400 New Born Care Corners established; more than 1.5 lakh MCH level I facilities
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CHW approach for care of newborns and children
Incentivising ASHAs for providing HBNC Schedule of home visits: For institutional delivery –
6 home visits (Days 3, 7, 14, 21 , 28 and 42) to assess newborn & provide post partum care to mother
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One extra visit within 24 hours of birth
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CHW approach for care of newborns and children
• Healthy Child Package – A demo course on this package was held at Sewagram in Sep 2011 – Adaptation of the package is being undertaken (with WHO support) – In collaboration with Ministry of Women and Child Development 15
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Hospital care of sick newborns and children:
Facility-based IMNCI (F-IMNCI):
• Training package based on WHO Pocket Book prepared in 2010 • Master trainers trained and training facilities identified in all the states • Most of the states have initiated F IMNCI training
Management of Severe Acute Malnutrition:
• Training Package for Facility based Management of SAM • Operational guide for Facility-based Management of Children with Severe Acute Malnutrition
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Facility-based Newborn care
Training package and operational guidelines for facility based newborn care developed Health Facility Primary Health Center/ Sub-centre identified as MCH Level I Community Health Center/ First Referral Unit identified as MCH Level II District Hospital identified as MCH Level III All Newborns at birth
Newborn Corner in labor rooms Newborn Corner in labor rooms and in operation theatre (OT) Newborn Corner in Labor Room and in operation theatre (OT)
Sick Newborns
Prompt Referral Neonatal Stabilization Unit Special Newborn Care Unit (SNCU)
Quality Assurance System for Special Newborn Care Units is being developed 17 | India | Regional CH Meeting | Kathmandu | 15 Nov 2011
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Facility-based Newborn care
Training package and operational guidelines for facility based newborn care developed Facility for newborn care
Newborn Care Corner
All Newborns at birth
All delivery points and operation theatres where obstetric procedures performed Neonatal Stabilization Unit Community Health Center/ First Referral Unit identified as MCH Level II Special Newborn Care Unit (SNCU) District Hospital identified as MCH Level III
Quality Assurance System for Special Newborn Care Units is being developed 18 | India | Regional CH Meeting | Kathmandu | 15 Nov 2011
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Current Status of FBNC in India
S. no. Indicator 1 2 3 Operational Special Newborn care units in India Operational Newborn Stabilization units in India Operational Newborn Care Corners units in India Comment 263 1120 6403 19 | India | Regional CH Meeting | Kathmandu |
Source: State PIPs 2011-12, March 2011
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Janani-Shishu Suraksha Karyakram
(Cashless Assured Services for Mothers & Newborns)
Entitlements for pregnant women & sick newborns (30 days)
Free & zero expense delivery and Caesarean section Free drugs and consumables Free essential diagnostics Free provision of blood, if required Free diet Free transport from home to back home Exemption from all kinds of user charges 20
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Programme Review and Management
• CH Short Programme Review (Sub-national) – First SPR at state level held in Sep 2010 – Subsequently, SPR conducted in two more states – Decision to include Program Managers Course An integrated Short Program Review for RCH is being developed (Will be ready for piloting in Dec 2010) • Programme Management Course (in collaboration with WHO/ UNICEF) – First demo course held in Sep 2010 – An integrated package for Program Managers in RCH being developed (Will be ready by Mar 2012) – A continuum of package 21
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Health Management Information Systems (HMIS):
Key indicators for newborn and child health
• • • • • • • • • • Newborns weighed at birth Newborns having weight less than 2.5 kg Newborns breast fed within 1 hour Women receiving post partum check-up a) within 48 hours after delivery b) between 48 hours and 14 days Infants 0 to 11 months old who received: BCG, DPT 1-3, OPV 1-3, Hep B 1 3, Measles Number of cases of Childhood Diseases reported during the month (0-5 years): diphtheria, pertussis, tetanus, polio, measles, diarrhea, dehydration, malaria, respiratory infections Anganwadi centres reported to have conducted VHNDs Institutions having operational Sick New Born Care Units Stock balance in the store on the day of the reporting month; vaccines, Paediatrics Antibiotics, IFA Syrup (Paediatric), Vit A solution, ORS Infant/ Child Deaths up to 5 years by cause Dashboard Indicators (Key Performance Indicators) for Newborn and Child Health have been identified for the country and a system to monitor these indicators at district/ state and national level is being developed)
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Health Management Information Systems (HMIS):
Key features of the HMIS
• Web-based data capturing system • Key indicators to be generated for local level use • Intelligent analysis for use at all levels • Standard and custom reports • National, state and district level fact sheets • Integration of health related information across programs 23
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Future Plans:
Strategic Action Points under Child Health Strategy
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Provision For Essential New Born Care Expansion of services for care of sick newborn and free referral transport Management of children with malnutrition Infant and Young Child Feeding Practices Micronutrient supplementation Management of Diarrhoeal Diseases Management of Acute Respiratory Infections IMNCI & F-IMNCI Improving Immunisation Coverage Eliminate Measles related deaths
Dedicated IEC for Child Health to improve Community Practices Monitoring on Child Health Dashboard Indicators at National/ State/ District level 24
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Future Plans
The environment: Twelfth Five-Year Plan
• Increased fund allocation • Universal health coverage • Innovative management reforms within health delivery systems to improve efficiency, effectiveness and accountability • Commitment to address childhood malnutrition
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