Mother and Child Health: Status, Challenges and Way Forward

Transcription

1 Mother and Child Health: Status, Challenges and Way Forward 3 rd India Health Summit, Hyatt Regency, New Delhi November, 2005 Dr. Siddharth Agarwal Urban Health Resource Centre [formerly EHP India]

2 Over view of the presentation Status of Mother and Child Health in India Operational Challenges Suggestions for Way Forward

3 Status of Mother and Child Health in India

4 Maternal and Child Mortality in India Annual Mortality Estimated Numbers Proportion of global Maternal deaths 0.13 million 25% Child deaths 2.4 million 22% Infant deaths 1.7 million 24% Neonatal deaths 1.2 million 30% Reduction in MMR from 407/1 (1998) lakh live births to 100/1 lakh live births by 2015 (MDG) Reduction in U-5 MR from 87/1000 (2003) live births to 41/1000 live births by 2015 (MDG)

5 Concerted efforts in mission mode are needed if India is to achieve MDG U-5 MR Years * * MDG Source: accessed on 20 th Oct, 2005

6 Causes of Maternal Deaths Half the maternal deaths are directly or indirectly contributed by anemia Mal-position 7% 14% Others 24% Anemia Sepsis 10% Toxemia 10% 12% 23% Hemorrhage Abortion Source: Registrar General India, Survey of Causes of Death,1998

7 Causes of Infant Deaths Over 70% of infant deaths are preventable through inexpensive and many through home based care Source: SRS 1998

8 Nutrition status Every second child is undernourished Every second woman is anemic 20 0 Malnourished (< 2 SD) Anemia among women Average Source: International Institute for Population Sciences (IIPS) and ORC Macro National Family Health Survey (NFHS-2), ; India. Mumbai: Siddharth IIPS Agarwal (2005). Mother and Child Health: Status, Challenges and Way Forward. Presentation made at 3rd India Health Summit organized by CII

9 Service Coverage Poor coverage of essential MCH services ANC+TT+ IFA Institutional deliveries Complete Immunization of children Source: International Institute for Population Sciences (IIPS) and ORC Macro National Family Health Survey (NFHS-2), ; India. Mumbai: IIPS

10 Socio-economic Differentials in Child Mortality Average data masks the real Child health Scenario among the poor (one-thirds of India s population) U-5 MR 0 Home deliveries Average Average-R Average-U Poor Source: International Institute for Population Sciences (IIPS) and ORC Macro National Family Health Survey Siddharth (NFHS-2), Agarwal (2005) ; Mother India. and Child Mumbai: Health: Status, IIPS Challenges and Way Forward. Presentation made at 3rd India Health Summit organized by CII

11 Regional differences in IMR Infant and Child survival substantially lower in EAG or BIMARU states (40% population) and NE states IMR Kerala HP Goa Average MP UP Meghalaya Source: International Institute for Population Sciences (IIPS) and ORC Macro National Family Health Survey (NFHS-2), ; India. Mumbai: IIPS

12 Child Health and Survival in Urban slums Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages Under 5 Mortality * Infant Mortality * Neonatal Mortality * Nutritional Status Rural Average Urban Average Urban Poor * Mortality per 1000 live births [Re-analysis of NFHS 2 ( ) by Standard of Living Index, EHP: 2003]

13 High Prevalence of HIV/AIDS HIV estimates 2004 (in lakhs) Rural Urban Total High risk of transmission from infected parents to children during pregnancy, delivery and breastfeeding Source: Accessed on 20 th Nov, 2005

14 What are the challenges in addressing compromised MCH scenario in our country?

15 Challenge # 1 Insufficiency of essential MCH Services Human resource shortage at PHCs Private sector not affordable by the 300 million poor Weak management capacity among public sector to rapidly expand services Weak Monitoring & Evaluation systems

16 Challenge # 2 Weak Demand Among Poor Communities Low awareness about services, behaviours and provisions Weak capacity to negotiate for MCH services

17 Challenge # 3 Gender Inequity Low awareness and compromised confidence among women to assert for and obtain needed health care Insufficient family support to women

18 Challenge # 4 Poor Reach and Access of MCH Services Poor reach to distant rural/tribal areas Poor social access to slum population and other urban poor despite geographical proximity

19 Challenge # 5 Urban Poor Mother and Child largely neglected Large proportion of the over 70 million urban poor grossly underserved with MCH services Illegality and invisibility of slums despite the economic contribution of this large informal work force

20 Challenge # 6 Weak Policy Implementation Despite well formulated and continually improving policy and program documents, implementation is weak: Allocated resources are not spent at optimum pace and consequently allocation is reduced Benefits do not reach where the need is maximum

21 Suggestions for the Way Forward

22 Action Point # 1 Strengthen and Augment MCH Services Identify and map un-reached population in villages and urban slums Strengthen MCH services including outreach activities especially to vulnerable pockets Promote Public Private Partnership for expanding and improving health services Strengthen inter-sectoral coordination at all levels Provide motivational training to health personnel (ANMs, Supervisors, MOs)

23 Key Contacts in Lifecycle for Delivering the Package PREGNANCY : TT, IFA, deworming, diet, EBF, birth preparation DELIVERY-28 days: safe delivery, EBF, immunization 0-6 months: EBF, OPV, BCG, DPT months: appropriate CF & SNP at AWC (frequency, amt active feeding, illness), measles vaccination, vitamin A, iron supplements 6-12 months: appropriate CF & SNP at AWC (frequency, amt active feeding, illness), measles vaccination, vitamin A, iron supplements 3-6 years: SNP at AWC.ADOLESCENTS (IFA, edu.)

24 Action Point # 2 Reach out and Strengthen Community Capacity Increase awareness about optimal behaviors, services and provisions Build capacity of underserved communities to negotiate, improve behavior by strengthening CBOs Promote demand and community- providers linkages through trained Community Health Volunteers via NGO partnership Encourage Community Health Groups, Health Funds (risk insurance), nutritional gardening Promote gender balance to enable women to take better care of their health

25 Community Health Funds Health funds are used to address obstetric emergencies, infants illnesses and also serve as an empowerment mechanism

26 Nutritional Gardening

27 Action point # 3 Enable and empower Adolescent girls Be prepared for motherhood (including being better nourished) and care of children Be able to delay age of marriage & child bearing Contribute as effective change agents Enable them to grow into productive women and foster gender equity

28 Action point # 4 Public Private Partnership Private sector caters to most of the health needs even among the poor PPP can be an important strategy for meeting the critical public health challenge of quickly expanding services in underserved areas. Utilizing existing private infrastructure (where available) rather than building new infrastructure saves time and costs eg. in Guwahati PPP can help in improving quality and broadening range of services Private NGOs can help improve community demand and hence increase utilization of existing services

29 A possible PPP Approach Bringing Health Services to Un-reached Areas Corporate & NGO Spo Co mpany... nsored by: Outreach 10,000 Outreach 10,000 Government 1.Vaccine 2.Other supp. 3.Coordination Referral to Identified FRUs/Charitable Trust Outreach 10,000 Several Private agencies operates mobile health care vans to reach unreached populations

30 Another possible PPP Approach Part-time Outreach Services by Private Doctors Socially Committed Private Doctor [receives honorarium from Govt] (about 3-4 hrs every Sunday) Week 1 Week 3 Village popln Village popln Week 2 Nodal Govt./Municipal Dispensary 1.Vaccines 2.Other supplies 3.Coordination 2 nd tier Govt./Private Centre Referral from slums to Govt. Dispensaries or 2 nd tier Govt/Private centre Week 4 Village popln Village popln Social Mobilization by NGO Identifies and trains health volunteers Supports community mobilization Supports outreach services Builds linkage between community, health providers District NRHM/RCH Unit Coordinates with private doctors, NGOs, nodal Dispensary, Coordinates periodic review Under the govt. immunization and scheme Indian Healthcare there is provision Federation. of New Rs. Delhi, 1400 November for 4 camps 21-23,2005 to be held in a village/slum per month

31 Action point # 5 Corporate Social Responsibility for MCH Supplement Health Investments and services needed to address MCH challenges Share expertise pertaining to demand generation, marketing and management Advocate for enhanced attention to mother and child health CSR is not just charity; it is an integral part of doing business -View expressed by several Corporate leaders

32 A possible Approach Corporate Partnership with Govt for expanding services Vaccines Supplies Referral support Coordination Socially committed Corporate Hospital CSR In-charge MCH Service Team Residents+nurse Social Mobilizer [Full time] Reporting Nodal Government Health Facility (1 st Tier Centre) Private / Govt. 2 nd tier health center MCH service team provides out reach services for 4-5 hrs every Sunday Social mobilizer Identifies and trains community volunteers Supports community mobilization Supports outreach services Serves as link between community, health providers and Corporate Hospital Referrals to Govt. Dispensary and 2 nd tier Govt/Private Centre Community popln Community popln Community popln Community popln Outreach services include treatment of minor illnesses, ANC, immunization, health counseling

33 Action point # 6 Energetic and Accountable Policy Implementation Ensure Govt. allocation is utilized effectively and speedily through improving management and financial systems Enable and support a missionary zeal in policy implementation by training and motivating officers Increased information about policy provisions to underserved people Real progress on inter-sectoral approaches is vital

34 Action point # 7 Partner effectively with Media An important collaborator for awareness and change Media can create social uproar to influence politicians, other Govt. departments, corporate sector and highlight plight of mothers and children [malnutrition, un-safe deliveries, lack of immunization] Can document and disseminate best practices from working models to encourage and inspire others e.g. Jamkhed, Pachod, Streehitkarini, SNEHA (all Maharashtra), Sumangli Sevashram Bangalore Can partner for promoting health behaviors e.g immunization, breast feeding. Examples of effective partnering with media include Pulse Polio Campaign, HIV/AIDS Awareness, Anti-Smoking Campaigns

35 Action point # 8 Develop dedicated MCH program for Urban poor Identify and map all urban poor including unlisted clusters Focus on water and sanitation services to slums Enhance role and capacity of municipalities Strengthen attention to MCH services within Urban Renewal Mission

36 Action Point # 9 Translate words into real Action Urgent action is needed on the ground to reach the underserved for India to move towards MDGs and NRHM goals Time is Essence in Public Health We cannot wait

37 Let us build a people s movement for maternal and child health and nutrition