Child Heath- status and
Initiatives in Gujarat
Dr Siddharth Nirupam
Presentation outline
 Current Status of Child Heath
 Mortality trends
 Causes of Child Death
 Child Nutrition
 Priority intervention (within continuum of care)
 Programme Thrust- Reaching the Unreached
 Where are the unreached- mapping and HP areas
 Why they are not reached- barrier identification and
action
Trend of Infant Mortality Rate
(IMR) in Gujarat
60
54
53
52
50
@ 3 per year i.e.
6.8 & 7.3 %
48
50
IMR per 1000 Live Births
44
41
40
30
38
@ 1 per
year i.e.
1.9%
@ 2 per
year i.e. 2.8
&4%
35
29
@ 4 per year
i.e. 8.3 %
24
20
10
0
NRHM Chiranj 108 Nirogi BalSakha
Bal
eevi
2005
2006
2007
2008
2009
2010
Source: SRS Infant Mortality Estimates
2011
2012
2013
2015
2017
Causes of under- Five Death
Child Nutrition Status - Gujarat
Source:- NFHS- 3 (2005-06)
Too Thin for Age
44.6
%
55.4
%
Normal %
[Green]
28.3
%
Moderate Under
Weight % [Yellow]
16.3
%
Severe Under
Weight % (Red)
Underweight (%)
Too Thin for Height
18.7
%
12.9
%
Moderate Acute
Malnutrition
(MAM) %
5.8%
Severe Acute
Malnutrition
(SAM) %
Wasting (%)
Priority Interventions for Child Health
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
1.
Gujarat’s Child Health Programme within
Continuum of Care
Time Period
VHND – Mamta Abhiyan, e Mamta
JSSK, FRU
3 levels of care- Family care, outreach, Facility
Adolescent
N
U T R I T I O N
Pregnancy
KPSY-1
IMNCI Plus
JSY
M I S S I O N
Delivery
Newborn
NSSK
FBNC
KPSY-2
RSBY
MA
Infant
Follow up of LBW & SCNU
Discharged
KPSY-3
Bal Sakha Ext. BalSak (Trbl Bloks)
Chiranjeevi Yojana
EMRI-108
Khilkhilat
Evaluated Achievements of key Interventions across life stages- Gujarat
Adolescen
ce
Pre-preg
Pregnan
cy
Delivery
Postnatal
Neonatal
Infancy
(%-National Average)
Data source: CES 2009;DLHS 3
Newborn Care Continuum
Home based
NB Care
• By 34,000 ASHA at home
Emergency
Medical
Transport
• Linkages with 108,
• Free drop back for Mother & Baby (JSSK)
• Strengthening of inter-facility Transport
Facility Based
Newborn Care
• Co-ordination with other departments
• Newborn Care Corners NBCC-562 units;
Newborn Stabilization Unit NBSU -153 in
FRUs/CHCs
• Sick Newborn Care Units SNCU : 34 units in DH,
MC, NGO
• Availability of skilled HR- Bal sakhaYojana
Role of Private Sector - (Diarrhoea)
Curative care & Private Sector
CES -2009
ORS Use Rate
56.9
60
50
40
30
36.7
24.4
20
10
0
DLHS-2
DLHS-3
CES-2009
Children Treated with ORS
Undernutrition in Gujarat
coverage of 10 proven interventions for its reduction
100
The Goal  100%
%
1. Initiation of BF < 1 hr ***
75
2. Exclusive BF upt 6 mo
3. Introduction of CF at 6-9 mo
4. Three expected IYCF practices
50
5. Stools safely disposed
6. Vitamin A supplementation (0-35 mo)
7. Adolescent girls (15-19 yr) non-anemic*
25
8. Households with iodized salt (>15 ppm)*
9. Diarrhea: Children fed <= usual (0-2 years)*
10. SAM: Children with acces to care**
0
Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India
***Coverage Evaluation Survey, UNICEF,2009
BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition
Reaching the Unreached for Child
Health
Where are The
unreached?
IInfant Mortality trends- Rural Vs Urban
Death rates higher in rural but
Urban poor death rates > urban average
IMR in ST > State average
48
41
27
Goal 27
Latest SRS reference -2009 by RGI
Immunization Status by Wealth Quintile, Gujarat
Coverage Evaluation Survey, 2009
Disparity in Infant Feeding by District
1. BF: Timely Initiation
3. CF: Timely Introduction
2. Exclusive BF: 0-6 mo
IYCF: Composite Index (1+2+3)
DLHS-3
Gujarat High Priority Districts (8)
HPD and Tribal districts
HPD but not Tribal districts
Reaching the Unreached for Child
Health
Why are they
unreached?
Six Coverage determinants- Tanahashi Model
Effective Coverage -quality
Adequate Coverage -continuity
Utilization -first contact
Geographical Access
Availability of Human Resources
Availability of drugs/supplies
18
Immunization Coverage- where is the gap
Fully
Immunized
(69%)
Effective
coveragequality
Adequate coverageContinuous
(Measlescontinuity
coverage (79%)
Utilisation
– 1rst contact
with services
Initial
Utilization
(BCG coverage
( >95%- DLHRS 11)
Accessibility
– physical
accessdiwas
to services
Functional
Access
to Mamta
(near 100%)
Accessibilityof– to
human resources
Availability
vaccinator
(near 100%)
Availability –ofcritical
inputs
health (near
system
Vaccines
and to
Supplies
100%)
ImmunizationTarget
ProgramPopulation
aim 100% coverage
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
Some Common Bottlenecks in Child
Health Programming in India
 Limited availability of Human Resources
 Low availability and access to Child Health in some areas




e.g. Urban
Low Demand generation in some areas
Low skill building- e.g. Facility Newborn care
Transport/ communication gaps in difficult areas
Inadequate supervision
Data Quality
Suggested Issues for Child Health
Programming
 Unreached Areas
 Rural- Drilling down to at least taluka level for local barrier
analysis and local solutions
 Urban Poor- Mapping, infrastructure, service delivery, MIS
 Child Malnutrition- Experiences from other countries IYCF communication; SAM management; Micronutrients
 Gram Sanjivini Samiti - Increasing community participation
 Emergency Transport- number and type for difficult areas
 Strengthen Supportive supervision for skills and quality
 Private sector- Evolving relationship
Thanks