Meeting of South-East Asia
Regional Programme
Managers on Child Health,
Kathmandu, 15 – 18 Nov 2011
PROGRESS IN
IMPLEMENTION
OF CHILD HEALTH
PROGRAMS
INDIA
1|
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
1
Trends of U5MR & IMR from 1990 -2009
140
Total Under-five
deaths:
1,696,000
Total Infant
deaths:
1,305,000
120
118
100
80
97
80
85
74
60
Total Neonatal
deaths:
875,000
Acceleration
Required
77
68
58
IMR
64
U5M
R
50
40
39
27
20
0
1985
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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
1990
1995
2000
2005
2010
2015
2020
3
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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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
4
Causes of under-five deaths in India:
2010
Malnutrition
34%
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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
5
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.
Absolute change (decline) in NMR
13
11 1010
9
9
8
7
9
9
9
7
55
5
9
8
4
4
2
3
3
3
Absolute change (decline) in IMR
2
2
9
7
6
2
10
9
8
6
3
5
22
1
1
1
0
0
0
6
4
-1
-3
6
imachal Pradesh
ammu & Kashmir
Jharkhand
Assam
Haryana
Uttar Pradesh
Maharashtra
Bihar
Delhi
Gujarat
Andhra Pradesh
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
Rajasthan
Punjab
India
Karnataka
Kerala
Madhya Pradesh
West Bengal
Tamil Nadu
Chhattisgarh
-3
-5
6|
5
0
-1
Orissa
Absolute change in NMR/IMR
15
Undernutrition in India
50
48
42.5
45
40
35
30
25
19.8
20
15
< - 3SD
Nearly 8 million children with Severe
Acute Malnutrition
10
5
6.4
0
Stunted
7|
Undernourished
NFHS
3,| 2005-06
India | Source:
Regional CH
Meeting
Kathmandu | 15 Nov 2011
Wasted
7
IMNCI Implementation
IMNCI implementation started (If yes, year)
2002
Newborn Added (If yes, year)
2002
Number and Proportion of districts implementing
IMNCI
433/640
68% (Jun 2011)
Number and proportion of Health Providers trained
(districts included in state PIPs till Dec 2010
59%
Proportion of districts (out of IMNCI districts) with
50% or more health providers trained
155/326
47.5% (Mar 2011)
IMNCI supervisory checklists introduced
No
Proportion of first-level health facilities that had at
Data not available
least one supervisory visit over a period of 6 month
during previous year
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)
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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
Data for 14 States
9
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
Sub-national review
conducted in Gujarat,
Rajasthan and Karnataka
Data not available
Pre-Service IMCI teaching/training:
Number and proportion of Medical
Schools teaching IMNCI
Medical colleges in several
states (approx 1/3 rd of
medical colleges)
Number and proportion of Nursing
Schools teaching IMNCI
Training introduced in nursing
and ANM schools in Orissa
and Rajasthan.
ICATT introduced (If yes, year and
scale)
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:
•
•
•
•
•
•
•
11 |
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
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
11
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
Module 6
1.
2.
3.
4.
5.
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
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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
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
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
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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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
13
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
14 |
For Home Delivery- 7 home visits
One extra visit within 24 hours of birth
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
14
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
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India | Regional CH Meeting | Kathmandu | 15 Nov 2011
15
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 FIMNCI 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
16 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
16
Facility-based Newborn care
Training package and operational guidelines for facilitybased newborn care developed
Health Facility
All Newborns at
birth
Sick
Newborns
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
Newborn Corner in
labor rooms
Prompt Referral
Newborn Corner in
Neonatal
labor rooms and in
Stabilization
operation theatre (OT) Unit
Newborn Corner in
Special Newborn
Labor Room and in
Care Unit
operation theatre (OT) (SNCU)
Quality Assurance System for Special Newborn Care Units is being developed
17 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
17
Facility-based Newborn care
Training package and operational guidelines for facilitybased newborn care developed
Facility for
newborn care
All Newborns at birth
Newborn Care
Corner
All delivery points and operation theatres
where obstetric procedures performed
Neonatal Stabilization Community Health Center/ First Referral
Unit
Unit identified as MCH Level II
Special Newborn Care District Hospital identified as MCH Level III
Unit (SNCU)
Quality Assurance System for Special Newborn Care Units is being developed
18 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
18
Current Status of FBNC in India
S. no. Indicator
Comment
1
Operational Special Newborn care units in
India
263
2
Operational Newborn Stabilization units in
India
1120
3
Operational Newborn Care Corners units in
India
6403
Source: State PIPs 2011-12, March 2011
19 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
19
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 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
20
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 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
21
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 13, 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)
22 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
22
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 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
23
Future Plans:
Strategic Action Points under Child Health Strategy
•
•
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
24 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
Dedicated IEC for Child
Health to improve
Community Practices
Monitoring on Child Health
Dashboard Indicators at
National/ State/ District
level
24
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
25 |
India | Regional CH Meeting | Kathmandu | 15 Nov 2011
25
Thank You