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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 - PowerPoint PPT Presentation
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Child Heath- status and
Initiatives in Gujarat
Dr Siddharth Nirupam
Presentation outlineCurrent Status of Child Heath
Mortality trendsCauses of Child DeathChild Nutrition
Priority intervention (within continuum of care)Programme Thrust- Reaching the Unreached
Where are the unreached- mapping and HP areasWhy they are not reached- barrier identification and
action
Trend of Infant Mortality Rate (IMR)
in Gujarat54 53 52
5048
4441
3835
29
24
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2015 2017
IMR
per
100
0 Li
ve B
irth
s
@ 1 per year i.e.
1.9%
@ 2 per year i.e. 2.8
& 4 % @ 4 per year i.e. 8.3 %
@ 3 per year i.e. 6.8 & 7.3 %
NRHM Chiranjeevi
108 NirogiBal
BalSakhaSource: SRS Infant Mortality Estimates
Causes of under- Five Death
Too Thin for Age Too Thin for Height
Normal %[Green]
Severe Under Weight %
(Red)
Moderate Under Weight
% [Yellow] Moderate Acute
Malnutrition (MAM) %Severe Acute
Malnutrition (SAM) %
44.6%
Underweight (%)
55.4%
28.3%
16.3% 5.8
%
12.9%18.
7%
Wasting (%)
Source:- NFHS- 3 (2005-06)
Child Nutrition Status - Gujarat
1. 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
Priority Interventions for Child Health
Gujarat’s Child Health Programme within Continuum of Care
Time Period
KPSY-1 KPSY-2
KPSY-3
3 levels of care- Family care, outreach, Facility
VHND – Mamta Abhiyan, e Mamta
JSSK, FRU
FBNCNSSK
IMNCI Plus
Ad
ole
sc
en
t
Chiranjeevi Yojana
JSY
RSBY Bal Sakha Ext. BalSak (Trbl Bloks)
MA
Follow up of LBW & SCNU Discharged
EMRI-108 Khilkhilat
N U T R I T I O N M I S S I O N
Evaluated Achievements of key Interventions across life stages- Gujarat
Data source: CES 2009;DLHS 3(%-National Average)
Newborn Care Continuum
Role of Private Sector - (Diarrhoea)
ORS Use RateCurative care & Private SectorCES -2009
Undernutrition in Gujarat
coverage of 10 proven interventions for its reduction
Source: DLHS-3, 2007-08, *NFHS-3 data (2005-06) **data for all India***Coverage Evaluation Survey, UNICEF,2009BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition
The Goal 100%
%
Where are The unreached?
Reaching the Unreached for Child Health
41 48
27
Latest SRS reference -2009 by RGI
Goal 27
Death rates higher in rural but Urban poor death rates > urban averageIMR in ST > State average
IInfant Mortality trends- Rural Vs Urban
Immunization Status by Wealth Quintile, Gujarat
Coverage Evaluation Survey, 2009
DLHS-3
Disparity in Infant Feeding by District
3. CF: Timely Introduction
1. BF: Timely Initiation 2. Exclusive BF: 0-6 mo
IYCF: Composite Index (1+2+3)
Gujarat High Priority Districts (8)
HPD and Tribal districts
HPD but not Tribal districts
Why are they unreached?
Reaching the Unreached for Child Health
18
Six Coverage determinants- Tanahashi Model
Availability of drugs/suppliesAvailability of drugs/supplies
Availability of Human ResourcesAvailability of Human Resources
Geographical AccessGeographical Access
Utilization Utilization -first contact-first contact
Effective Coverage -qualityEffective Coverage -quality
Adequate Coverage Adequate Coverage -continuity-continuity
Immunization Coverage- where is the gap
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
Availability – critical inputs to health system
Adequate coverage- continuity
Utilisation – 1rst contact with services
Accessibility – physical access to services
Effective coverage- quality
Target Population
Accessibility – to human resources
Availability of Vaccines and Supplies (near 100%)
Availability of vaccinator (near 100%)
Functional Access to Mamta diwas (near 100%)
Initial Utilization (BCG coverage ( >95%- DLHRS 11)
Continuous (Measles coverage (79%)
Fully Immunized (69%)
Immunization Program- aim 100% coverage
Some Common Bottlenecks in Child Health Programming in IndiaLimited availability of Human ResourcesLow availability and access to Child Health
in some areas- e.g. UrbanLow Demand generation in some areas Low skill building- e.g. Facility Newborn
careTransport/ communication gaps in difficult
areasInadequate supervisionData Quality
Suggested Issues for Child Health ProgrammingUnreached Areas
Rural- Drilling down to at least taluka level for local barrier analysis and local solutions
Urban Poor- Mapping, infrastructure, service delivery, MISChild Malnutrition- Experiences from other countries-
IYCF communication; SAM management; MicronutrientsGram Sanjivini Samiti - Increasing community
participationEmergency Transport- number and type for difficult
areasStrengthen Supportive supervision for skills and quality Private sector- Evolving relationship
Thanks
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