Transcript Accelerating Child Survival and Development in Gujarat and

Accelerating Child Survival and
Development in Gujarat and in India
Dr Genevieve Begkoyian, MD MPH
Chief of Health,
India Country Office
Healthy Gujarat – Agenda for Action
Mahatma Mandir, Gandhinagar, Gujarat
3 December, 2013

India today
• No case of polio in 33 months
• 60 million new toilet users
• 11.1 million more children in school
And ….
• Food security
passed
 Stunting decreased by 16% in Maharashtra
sincebill
2006
 U5MR reduction from 118 to• 55Nutrition
between missions
1990 and formed
2011
• NMR
declined
by 9%
in 2 years
 IMR in Gujarat 10 points
decline
in last
3 years
Maternal Mortality in Gujarat
450
Current Interventions
389
Maternal Mortality Ratio
400
350
300
202
250
172
200
150
• SBA, BEmOC, CEmOC
•VHND/ Mamta Diwas
• Referral transport through EMRI 108
• Chiranjeevi Yojana
• Janani Suraksha Yojana
•Janani Shishu Suraksha Karyakram
• Focus on Adolescent Health
160
148
100
Goal
100
50
0
1989
Source: SRS 2007-09
1999-01 2001-03 2004-06 2007-09 2010-12
2015
Infant Mortality trends in Gujarat
140
 > 50,000 deaths among under-ones annually
 70 % infant deaths during neonatal period
120
100
80
Rural 45
60
Rural
40
Total 38
Total
20
Goal 29
Urban
Urban 24
Source: Latest SRS reference -2012 by RGI
2015
2013
2011
2009
2007
2005
2003
2001
1999
1997
1995
1993
1991
1989
1987
1985
1983
1981
0
Causes of Under 5 Deaths : India
Avoid preventable deaths
Data Source : CHERG Estimates for Causes of Under 5 Deaths 2012, based on 2010
Success factor 1
• Leadership at the highest level to
ensure priority to child health and
development outcomes across
sectors, with large investments
>7 millions children not imunized in India
69% of partially and
un-immunized
children in 6 states:
Data not available
Below 5 %
5 % - 10 %
>10 % - 25%
>25 %
Source: CES 2009; Full immunization of children surveyed 12-23 months
•Uttar Pradesh
•Bihar
•Madhya Pradesh,
•Rajasthan
•West Bengal
•Gujarat
Identification of High Risk Areas, India, February 2013
Migrant sites
= 10 Migrant sites
~ 256,000 Migrant sites
High risk areas in
settled population
= 10 HR sites
~ 166,000 HR areas in settled population
Full Immunization (%)-State wise coverage
40.9
42.9
51.9
56.6
57.3
59.1
60.8
61.0
66.0
71.5
71.5
75.8
77.3
71.7
66.6
64.9
59.7
53.8
49.0
50.0
59.5
60.0
Reaching the 7 millions children un immunized
68.0
70.0
78.0
80.0
78.6
81.5
83.6
85.3
87.9
90.0
73.7
All India immunized children
100.0
30.0
20.0
10.0
0.0
Source: CES (2009)
27.8
40.0
Success factor 2
RESULTS BASED focusing on
most deprived
Reduction in neonatal
mortality
Focusing together
on those at highest risk: the Adolescent
departments and cross line ministries coordination
• Inter
Adolescent
– Out of school
– Early marriage
– Early pregnant
– Anemia, Malnutrition
• High risk Mother & child
Focus of QUALITY care
including nutrition and
hygiene practices
– Prematurity
– Low birth weight
– Post partum Hemorrhage
Zero tolerance to maternal and newborn death
Success factor 3
Evidence based:
facility based,
outreach
community based strategies
Continuum of care for new born survival
Newborn
Stabilization
Units
IMNCI
/ HNBC
/ NBCC
Community/PHC
level
Continuum of Care
CHCs at block
level
SNCU
District Level
Madhya Pradesh SNCU : 2008 - 2012
80000
70000
Total Admissions : 137,186
Mortality : 12.8%
Admission
Death
60000
55619
Number of Admissions
50000
39785
40000
30000
25156
20000
14187
7241
10000
2439
336
1902
2999
5107
0
2008
2009
2010
2011
2012
Projected Admissions for 2013 in India: 450,000
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
Hygiene protocols for RMNCH +A
PLUS
5 Cleans
Clean hands
Functioning toilet and HWWS
facilities
Clean surface
Hand Soap
Clean blade
Surface cleaning agents
Clean cord
Clean water supply
Clean thread
Laundry facility
Safe delivery &
new born care
Disposal bin
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
Behavior
change for
healthy life
sustainable
practices
…but
the change is
possible
The change is
happening…
THANK YOU