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Child Health Strategy in RCH II

Child Health Strategy in RCH II. 7 th October 2008. National Goals more ambitious- MDGs. Steady Decline in Infant Mortality Rates. Infant Mortality Rates in India: Decline STAGNATING!. 12 Points. 34 Points. Infant Mortality Rates in India Rural Urban divide.

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Child Health Strategy in RCH II

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  1. Child Health Strategy in RCH II 7th October 2008

  2. National Goals more ambitious- MDGs

  3. Steady Decline in Infant Mortality Rates

  4. Infant Mortality Rates in India: Decline STAGNATING! 12 Points 34Points

  5. Infant Mortality Rates in India Rural Urban divide

  6. Childhood Mortality Rates by Sex

  7. Breastfeeding Complementary feeding ORT Zinc for diarrhoea Antibiotics for pneumonia 50/1000 live births 54/1000 live births 48/1000 live births 55/1000 live births 54/1000 live births Solutions for reduction of IMR within reach

  8. Deaths prevented by care at home, outreach & at facility in India

  9. RCH II • Integrated Management of Neonatal and Childhood Illnesses (IMNCI) • Home Based Newborn and Childhood Care • Facility Based Care - SNCUs • Infant & Young Child Feeding & Nutrition Rehabilitation Centres • Micronutrient supplementation – Vitamin A & Iron folic acid

  10. Child Health strategy Newborn & Child Health Prevn & Tx mild illness IMNCI Care at birth Tx serious illness Immunization Facility Home Community Outpatient Inpatient Home Functioning Health System BCC & Community mobilization

  11. Causes of infant mortality in India Primary causes of neonatal deaths in India (Source: National Neonatology Forum and Saving Newborn’s lives, 2004)

  12. IMNCI addresses causes of deaths Newborn & YI 0-2mo Conselling: BF,CF, immunization Diarrhea IMNCI Malnutrition/ Anemia ARI Fever/ measles/ malaria

  13. India IMCI program is oriented to the newborn and young infant

  14. IMNCI components and intervention areas Improve family & Improve health Improve health community worker skills systems practices Case management District & block planning and    Appropriate standards & management Care seeking guidelines   Availability of IMNCI drugs Nutrition  Training of   facility-based public Quality improvement and Home case supervision at health health care providers management & facilities – public & private adherence to  IMNCI roles for private recommended  Referral pathways and providers treatment services  Maintenance of Community  Health information competence among involvement in health  system trained health services planning & workers monitoring

  15. High focus states ambitious but performance lags behind!

  16. Limitations of IMNCI • Outpatient Facility Based • Community activities not given adequate focus • Training centre of attention • Vertical initiatives in Non IMNCI districts sorely lacking

  17. Treatment of Childhood Diseases Percentage of children with childhood diseases taken to a health facility or provider • Diarrhoea: 60 percent • Acute respiratory infection (ARI): 69 percent • Fever: 71 percent

  18. Delay in getting treatment For mild and severe illness the behavior of caretaker is same.

  19. Reasons for seeking care outside home

  20. Location of Health Care Seeking Outside Home for Fever during two weeks prior to survey State Wise EAG States Non EAG States *The Govt HF facilities are utilized more in Orissa. While the utilization of private HF is more in Maharashtra, Kar and Haryana respectively. *The Govt HF is less utilized in UP while Pvt and informal are equally utilized *In Rajasthan Utilization of Informal is more than Pvt HF *In all non EAG states utilization of informal is less than Pvt HF *In EAG states Utilization of Informal and Pvt is almost same , except in Rajasthan

  21. Referral Advice Cont…

  22. Referral Advice Cont…

  23. Home visit during illness

  24. Knowledge of ORS Packets Nearly three-quarters of women know about ORS packets (up from 43% in NFHS-1 and 62% in NFHS-2). However, use of ORS is low and virtually unchanged since NFHS-2.

  25. Home Based Newborn Care • SEARCH model selected • Modules adapted • Permissions granted by DCG (I) • Funding from NIPI • Fell apart • Different states – different initiatives

  26. Facility Based Newborn and child care • Evaluation of GOI-NNF programme done • Being implemented by states • Sick Newborn Care Units (SNCUs) being set up – 57 by end of current year

  27. Latest available status of Vitamin ASource: Family Welfare Statistics 2006

  28. Limitations of different trainings • Management of multiple trainings difficult for trainers and trainees • Different programmes in different districts and at varying paces

  29. Health personnel level wise activities • Train nurses also on child health • Doctors and nurses integrate IMNCI(OPD care) with inpatient care • ANMs & AWWs & ASHAs _ integrate IMNCI (hw module) i.e OPD care with home based care • Saturation approach • Neonatal and Child health policy formulated

  30. Achieved 2007 goal Achieved 2012 goal Above nationalaverage 20 states 10 states 8 ( Assam, Bihar, Chattisgarh, Haryana, MP, Orissa, Rajasthan, UP) Centre of attention based on classification of states - IMR

  31. Family planning decreases IMR

  32. Thank you

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