Child Health Program

Ministry of Health and Family Welfare Government of India

Recent trends in Neonatal and Infant Mortality Rate

70 60 50 40 30 20 10 0
SRS 2004 SRS 2005 SRS 2006
Neo-Natal Mortality Rate

58

58

57

55

53

37
26

37 28

37 28

36 29

35
27

SRS 2007

SRS 2008

Infant Mortality Rate

Early Neo-Natal M.R.

Neonatal Mortality Rate shows stagnation; need to act IMR high in Bihar, Chhattisgarh, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and Assam

Child Health Strategies

Integrated Management of Neonatal and Childhood Illness (IMNCI)

Improve Health Workers skills Address issues in health system Improve Family and Community practices

Newborn Care Interventions

Navjaat Shishu Suraksha Karyakram (NSSK) Home Based Newborn And Child Care (HBNC) Facility Based Newborn Care By Establishing SNCUs, NBSUs And NBUs

Childhood Immunisation and Vitamin A Supplementation Standard Case Management for ARI and Diarrhea Management of Severe Acute Malnutrition

School Health Program

Districts Implementing IMNCI

States Districts Up to 2009-10 171 44 131 District Total sTarget 2010- Districts 11 86 28 52 257 72 183 Total Districts In States 311 88 221

Non Ne High Focus Ne States Non High Focus

Union Terr.
Grand Total

10
356

4
170

14
526

22
642

States With < 30% Of Districts Implementing IMNCIChhattisgarh, Himachal Pradesh, MP, Arunachal Pradesh, Meghalaya, AP, Punjab, West Bengal

Progress of facility-based Newborn Care

No. OF SNCUs

No. OF NBSUs

No. OF NBCs

States

Upto 0910
88 3 106 16

Target 1011
99 36 149 7

Upto 09-10

Target 1011
462 412 622 1

Upto 09-10

Target 1011
1608 288 3695 6

Non Ne High Focus Ne States Non High Focus Union Terr.

165 62 270 4

1662 438 2104 0

Grand Total

213

291

501

1497

4204

5597

Navjaat Shishu Suraksha Karyakram (NSSK)

Training on Basic Newborn Care and Resuscitation One trained person during every delivery Targets For 2010-11 For NSSK Trainings

States Non NE High Focus NE States Non High Focus Union Territory Grand Total

Medical Officers Staff Nurses 456 104 520 36 1116 1536 78 520 140 2274

Total 1992 182 1040 176 3390

Home-based Newborn Care

Home Based Care for - Neonates and Mothers

Home visits by health workers Promotion of Exclusive Breast Feeding HBNC has been developed for Use of ASHAs in Rajasthan, Bihar, Madhya Pradesh and Orissa Uttar Pradesh integrated HBNC with IMNCI as Comprehensive Child Survival Programme (CCSP) in 18 districts

ASHA Module 6 And 7 Have Been Developed

States Should Develop Plan For Implementing A Comprehensive Newborn Care Through HBNC

Management of Severe Acute Malnutrition

Status Malnutrition is an underlying cause in >55% of under-5 deaths Prevalence of Sever Acute Malnutrition 6.4% (NFHS 3, 0506)

Strategy Nutrition Rehabilitation Center established for management Of Severe Acute Malnutrition
Madhya Pradesh (121) and Maharashtra (438) Have Functioning NRC States Are Urged To Address The Issue Of Bihar, Rajasthan and Chhattisgarh have initiated the process

Malnutrition By Planning Establishment Of NRC

Treatment of Diarrhea

Under-five mortality attributed to diarrheal disorders 15% Percentage of children with diarrhea taken to a health facility or provider 60% Children <5 years with diarrhea in the last 2 weeks received some kind of oral rehydration therapy - 39%

26% received oral rehydration salt (ORS) packets 20% received gruel

16% received antibiotics, which are not normally recommended for treating childhood diarrhea Only 0.3% children suffering from diarrhea received Zinc supplements More than one-quarter did not receive any kind

of treatment

Highest and Lowest Use of ORS

State
Highest Meghalaya Tripura use
Himachal Pradesh Goa Mizoram

Percent children with diarrhea given ORS

65 58 56 51 48
17 17 17 15

Lowest use

Jharkhand Nagaland Rajasthan Assam

Uttar Pradesh

13

In 17 out of 29 states, less than one third children with diarrhea received ORS.

Treatment of Acute Respiratory Infections Under-five mortality attributed to ARI: 19% Children <5 years with ARI taken to a health facility or provider 69% Children <5 years with ARI received antibiotics 12.5%

Almost one-third did not receive any kind of treatment

Percent children <5 yrs with ARI taken to a health provider (State-wise)
State % Children with ARI taken to a health provider
89% 89% 88% 87% 77% 52% 45% 44% 34% 27%
NFHS - 3; 2005-06

Highest

Delhi Kerala Haryana Punjab Orissa Madhya Pradesh Manipur Arunanchal Pradesh Assam Nagaland

Lowest

Immunization Division, MOHFW, Govt. of India

Childhood Immunization (DLHS-3)

Coverage
Low (<50%)

States/UT
Uttar Pradesh, Meghalaya, Madhya Pradesh, Tripura, Arunachal Pradesh, Bihar, Manipur and Rajasthan Mizoram, Assam, Jharkhand, Gujarat, Chhattisgarh, Haryana, Orissa, Jammu & Kashmir, Uttarakhand, Andhra Pradesh, Delhi, D&NH and Maharashtra Chandigarh, West Bengal, Karnataka, Sikkim, Kerala, Punjab, Pondicherry, Himachal Pradesh, Tamil Nadu, Lakshadweep, A & N Islands, Daman & Diu and Goa

Medium (50-70%)

High (>70%)

Polio Cases, India

Most recent virus 28 May 2010 Birbhum, WB

WPVs State Jam m u & Kashm ir Maharashtra West Bengal Uttar Pradesh Bihar Haryana Total
* data as on 25 June 2010

P1 1 1 3 0 0 0 5

P3 0 0 0 10 6 1 17

Total 1 1 3 10 6 1 22

Improve coverage in NIDs and SNIDs Special strategy to reach migrant population

COLD CHAIN

New Initiatives

Measles second opportunity (69% national coverage)

Hepatitis B States Hepatitis B Pilot Districts

14 states for catch-up campaign 21 states for second dose under RI

Hepatitis B Pilot Cities

Hepatitis B Already in 10 states selected Expansion of Hepatitis B vaccine in the remaining states in phased manner Pentavalent Introduction of Hib-containing pentavalent in select states is under consideration
Immunization Division, MOHFW, Govt. of India

Utilization of allocated budget

States % States % States %

Tripura Rajasthan Madhya Pradesh

132 Orissa 130 Maharashtra 125 Uttar Pradesh

80 60 54

Gujarat 118 Kerala 98 Arunachal Pradesh 84 Assam 84 Andhra Pradesh * 81 Manipur 81

Uttarakhand 54 West Bengal 53 Karnataka 46 Jammu & Kashmir 40 Mizoram 40 Jharkhand 39

Haryana Nagaland Himachal Pradesh Bihar Tamilnadu Chhattisgarh Punjab Sikkim Meghalya

37 36 34 23 22 12 10 10 9

Issues for states

Scaling up of IMNCI (ANM) / F-IMNCI (MOs)/ Immunization must be accelerated to improve coverage at facility level

Supportive Supervision after training Improve availability of ORS, Zinc, Antibiotics

Additional strategy at community level for improving continuum of care:

Scale up implementation through ICDS (AWW) Utilize ASHA in managing Diarrhea and ARI like homebased Newborn care

Emphasis on monitoring of service utilization Strengthen cold chain system

THANK YOU