Transcript Intro

Improving Newborn-child survival in
India
Technical Advisory Group
Consultation
“Book of Proceedings”
Dr. Rajiv Tandon
Senior Advisor-MNCHN
Save the Children, India
[email protected]
+91-98111-03305
Maternal health in India
Status of Child Health in India
• Nearly 2 of 8 million U5 deaths per year, in India – the highest
anywhere in the world, 50% within their first month of life (LBW !!),
majority of deaths are preventable
• More than half of the children die in just 7 Indian states - Uttar
Pradesh, Madhya Pradesh, Rajasthan, Chhattisgarh, Bihar, Jharkhand
and Orissa
• More then 100 million U5 undernourished (8.5million - SAM)
• Only half U5 receive routine immunisation
• India ranks
•
171st of 175 countries in Public Health Spending
•
119th of 169 countries in Human Development Index
•
73rd of 78 countries as the best place to be a mother
•
67th of 84 countries in Global Hunger Index
URGENTLY NEED TO FOCUS ON NB & CS & UNDERNUTRITION!!!!!!
“Outside” Health Service
Interventions
• Treatment of severe newborn &
child illness
Referral
Level Care
1st level Private
Services
1st level Public
Services
Barriers, constraints,
Community Health
Interventions
Operational Framework
• Comprehensive obstetric care
facilitating factors
• ANC
• Immunization
• AWW, ASHA,
supervision &
supply
• Health
information
• Private
provider
Community
training
linkages to
• etc.
health
services
• Breastfeeding
• Feeding
• ORT
• Birth planning
• Newborn care
• Care seeking
• etc.
Family
practices
• Basic preventive services
(ANC, immunization, etc.)
• Primary treatment of MNCH
illness (IMNCI, basic essential
and emergency obstetric care)
• Counseling
• Transport of
complicated
deliveries and
sick children
• Organization
for ANC &
immunization
• Community
oversight and
monitoring
• etc.
Public
Care
delivered in
the
community
>60% of
Deaths
Private
• Safe/clean delivery
• Active mgt. 3rd stage of labor
• IFA
• LBW special care
• ORT
• Vitamin A, zinc
• Abx. for pneumonia
• etc.
When do Newborn Babies die?
ICMR 2004
“Where” to provide care?
Place of birth
Place of Death
80
Private
hospital
70
60
50
40
Home
Govt
hospital
30
20
10
0
e
m
Ho
NCMH, 2005
p
rs
te
s
e
u
th
Ho nro
O
E
ICMR HBYI study, 2005
Technical Advisory Group Consultation
• Objective: Developing strategic breakthroughs
needed to achieve a dramatic reduction in
newborn & child mortality in India
• 125 people/organisations – cross section of
leading experts in Government, Academia,
Corporates, Civil Society Organizations, Donors
• 3 day participatory process, facilitated (OST)
• 40 group work reports, prioritization of key
objectives & action plans (Book of Proceedings)
• 39 personal statements of commitments for
action
Key barriers to achieving positive MNCHN outcomes in
India
• Inadequate total funding & critical funding
gaps
• Significant gaps between policy & program
implementation (multiple fragmented
efforts)
• Lack of access for the poorest & most
vulnerable communities: girls, urban poor,
minorities, disabled, Dalits, tribals, migrants
• Poor quality of services
• Insufficient numbers, role definition,
capacity building, supervision of frontline
healthcare workers/supervisors
Key barriers to achieving positive MNCHN outcomes in
India (contd.)
• Lack of coordination between Ministries &
departments (and service providers)
• Lack of champions, platforms & institutions for
consensus building & joint actions
• Lack
of
governance
(Corruption)
&
mismanagement of funds & processes
• Insufficient community ownership, participation,
monitoring
• Inadequate data to inform decision making &
weak HMIS
• Lack of awareness (among the middle class) of
challenges for the poor
What needs to be done to improve newborn
and child survival in India?
TAG recommendations
India needs:
1. Increased investment for greater access to MNCHN
services
2. Convergence between government departments &
stakeholders for holistic, effective, equitable
implementation
3. Strengthened human resources, with special emphasis
on frontline health workers (newborn care, nutrition)
4. Enhanced accountability for responsible governance
5. Enhanced quantity, quality and availability of data to
inform decision-making
6. United social movement committed to bringing about a
dramatic reduction in child mortality
1. Increased investment for greater access to MNCHN
services
• Increase overall budget allocation for health to 3% GDP.
– 5% (if drugs and chronic diseases-related costs get special
focus)
– Allocate 25% for newborn & child health
– Link MNCHN indicators to economic growth indicators
– Introduce budget tracking tools and social audits
• Enhance access to vulnerable communities: women, Dalits,
tribals, disabled, religious minorities, conflict-affected and
remote communities, migrants, (250 highest need districts)
• Launch National Urban Health Mission
1. Increased investment for greater access to MNCHN
services (contd.)
• Technical & operational consensus for scaling up MNCH
through a continuum of care, “Deconstruct to Reconstruct” a
non branded, evidence based, cost effective model at scale –
“Adaptation process”
• Fiscal devolution policy – at districts/Block levels (Role of
DMs/BDOs)
• Develop gold standards for Quality of care
• Develop and implement Block level health service delivery
plans and resource hubs
• Invest in human resources for health
• Invest in infrastructure and new technology (ICT)
• Actualize Right to Food & Nutrition
• JSY to include MNCHN services
2. Convergence between government departments and
stakeholders for holistic, effective implementation
• Develop champions & leaders for MNCH at all
levels
• Form and actualize a MNCH coalition (Multistakeholder)
• Continuum of Care (HH, community, referral,
FRU) for MNCH
• Establish role clarity between departments &
programs (HFW, PHED, WCD, RD)
• Coordinate state PIP planning, targeting,
implementing, monitoring & budgeting across
departments
2. Convergence between government departments and
stakeholders for holistic, effective implementation (contd.)
• Develop and implement integrated awareness
campaigns & models of MNCH care
• Establish clear linkages & referral mechanisms
within & between departments & service
providers
• Mainstream NBCS into NDMA planning
• Engage private sector providers
3. Strengthened human resources, with special emphasis on
frontline health workers
• Increase fund allocation & number of frontline
health workers (Global code of Practice on
recruitment of health personnel)
• Rationalize health worker placement & workload
• Ensure equitable recruitment , selection process
& cadre reviews
• Clarify specific roles of ASHA, ANM (SBA), AWW
• Build capacity of workers through
comprehensive, participatory, skills-based
training
3. Strengthened human resources, with special emphasis on
frontline health workers (contd.)
• Place special emphasis on linking training & equipping
them with supplies
• Improve system of performance incentives & rewards
• Develop & implement supportive supervisory methods
& feedback mechanisms
• Streamline reporting expectations, processes to
address grievances
• Develop state HR plan & create HR management cells
• Establish block resource centers for ongoing capacity
building
4. Enhanced accountability for responsible governance
• Rights based approach (redressal and punitive action)
• Gender- Zero tolerance policy, gender budgeting in 12th - 5
year plan
• Greater role of Gram Sabhas, peer leaders, hamlet
representation
• Increase awareness at community level of rights and
entitlements (citizen charter, data triangulation)
• Equip community-based monitoring structures (VHSC, PRI,
SHG) with knowledge & tools needed to track services
delivered & identify unmet needs and link them with BDOs
• Civil society facilitated social audits, public hearings,
information sharing
4. Enhanced accountability for responsible governance (contd.)
• Link funding to Program success (outlays to outcomes)
• Increase financial transparency & timeliness of
processes
• Institutionalize minimum service guarantees &
redressal mechanisms
• Mobilize local & state media for public awareness on
gaps in implementation & transparency within the
health care system
• Media as agent of change – Media Leaders Summit on
MNCHN, National Media/Communications Consortium
• Generate competitive governance states, districts &
blocks
5. Enhanced quantity, quality and availability of data related to
the provision of MNCH services (encompassing technical,
financial, and managerial data) to inform decision-making
• Conduct thorough assessment of Health
Management Information Systems ,
concurrent/impact evaluations
• Invest in institutions and HR for MIS – COE, sentinel
sites
• Disseminate best practices in technical
interventions/services, financial management,
service supervision to key stakeholders including
government & non-government institutions, health
professionals & frontline workers & research
institutions
5. Enhanced quantity, quality and availability of data related to
the provision of MNCH services (encompassing technical,
financial, and managerial data) to inform decision-making
(contd.)
• Learn from best practices of southern states
• Engage private sector - regulatory frameworks,
ombudsman (avoid conflict of interest)
• ICT – GIS, smart phones, UID, e/m health, rapid visual
surveys, GPS, SMS (fund transfer), broadband tech.
• Conduct study on feasibility and cost-effectiveness of
various interventions
• Determine denominators (Scandal of invisibility!!)
• Rationalize unit of operationalisation - Block
6. United social movement committed to bring about a
dramatic reduction in child mortality
• International solidarity and political pressure to
make MNCHN a key priority within political agenda
• Engage with National consortium of MNCH academia
• Media mobilization to highlight scale of problem,
issues, gaps, human stories
• MDG4 tracking and update vis a vis other priority
countries
• Call for action to increase child health budget in the
next fiscal year
• Rights based mobilization demanding for legislation
Recent / upcoming developments
• Union Health & Family Welfare Minister: Health Sector
Priorities
• National consultation on MDG 4 (SC India) - Shadow report
• UN MDG Review Summit, New York
– Global Strategy for Women’s and Children’s Health by 2010
– SG’s Call to Action
• 2010 Countdown to 2015 Report
• Public Hearing (SC India)
• PMNCH partners meeting, Pledges to Action
– Delhi Declaration
• Newborn and Child Survival TAG (SC India)
– Book of Proceedings
– Approach Paper on Child Health, 12th Five Year Plan
• Lancet Series
– Towards Universal Health Coverage – 2020 in India
Recent / upcoming developments
• UN Commission on Information and Accountability for
Women and Children’s health (Harper and Kikwete), Geneva
– Monitor, Review, Remedy
– Working Groups for Results & Resources
– Independent Expert group on MCH report to UNGA
• Global Forum on Human Resources for Health, Bangkok
– Strategies and targets to close the health worker gap
• World Economic Forum, Davos
– Global Polio Eradication funding gap addressed
• G8: Paris, June
– Health systems strengthening
• UNGA : New York, September - Inform. & Accountability
Commission report
• G20:Cannes, November - Governance & innovative financing
Key recommendations and action steps
• Increase budgetary allocations 3% (25% to NBCH)
• Formation of a MNCH Coalition (Multi-stakeholder)
• Civil society organizations (e.g. Save the Children)
to input into 12th five year plan approach papers,
be a part of the advisory, thematic and steering
groups
• Participation in the reviews of National Programs
e.g. NRHM, ICDS, NREGA, SSA, TSC, MDM etc.
Key recommendations and action steps, contd.
• Immediate operationalisation of the revised Newborn
& Child Health policy & strategy (adequately costed &
funded)
• Regular high level oversight mechanisms for MNCH
– National Health Commission (PM/Parliamentary
committee with CSO)
• Collaboration using Implementation Science to
dramatically accelerate progress in meeting country
needs for preventing maternal and newborn deaths
• Institutions – platforms - champions!!!!
THANK YOU
Thank you