" Continuum of care-Extending horizons"

Dr. Vikas K. DesaiGujarat

State’s Target and Achievements

2H & FW Deptt.Health & Family Welfare Department

Trends of Institutional Deliveries

Source: HMISHealth & Family Welfare Department

Trend of Infant Mortality Rate (IMR) in Gujarat

54 53 5250

4844

41

35

29

24

0

10

20

30

40

50

60

2005 2006 2007 2008 2009 2010 2011 2013 2015 2017

IMR

per 1

000

Live

Bir

ths

@ 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 %

NRHM Chiranjeevi

108 NirogiBal

BalSakhaSource: SRS Infant Mortality Estimates

Trend of CBR & TFR (SRS)

Trend of CBR Trend of TFR Gujarat

2.82.7

2.62.5 2.5 2.5

2.4

2.22.12.00

2.20

2.40

2.60

2.80

3.00

2005 2006 2007 2008 2009 2010 2011 2015 2017

Gujarat

Child Sex Ratio (0-6 Years): India and Gujarat (Census)

H & FW Deptt. 6

SRS (2012)

Gujarat Maharashtra

TamilNadu

Kerala

Birth rate 21.1 16.6 15.7 14.9Death rate 6.6 6.3 7.4 6.9IMR 38 25 21 12MMR(SRS ‘07-’09)

148 104 97 81

Trend of BR (SRS)

15

21

Trend of IMR

Target by 2015 is 28/1000LB

GujaratDecline of 6 in 3 yrs.= Decline of 2 /yr. (3.4/yr to reach to 28by ‘15)

Not in the list of states In closer proximity to achieving the MDG target.

Malnutrition in <36months children (NFHS 3 ‘05-’06)

In Gujarat Compared to Kerala Underweight children are more by 18%

Wasting (Acute malnutrition) is almost sameStunting (Chronic Malnutrition) is more by 21%Gujarat needs special and high focus on

Adolescent and Pregnant mothers Nutrition also

CONTINUUM OF CARE (Lifecycle Problem and Approach)

CONTINUUM OF CARE(Quantity- Quality)

Doable / Simple to More technical• Immunisation- Polio, Measles• Institutional delivery - safe home delivery • Neonatal health focus in Infant health• Diarrhoea and Pneumonia management• SAM management (Bakshaktim kendra)• Service delivery - IPC• ENBC-IMNCI-FIMNCI

CONTINUUM OF CARE(Linking care)

CONTINUUM OF CARE(level of care -Home based to Tertiary care)

1. ASESS

2.CLASSIFY

3.MANAGEIMNCI

APPROACH

4. FOLLOW UP

“Healthy Child” Physically, Mentally, Socially and Spiritually

‘Womb to Adolescence” Lifecycle approach to Care

“ Universal Coverage” No child is left out due to poverty,geography, gender, Out of school, Challenged

“ Evidence to Action” Implementation of evidence based interventions

Nirogi Bal Varsh 2008 Concept

CONTINUUM OF CARE(Service Record Tracking )

Unique ID & Common

minimum E program

Data records To provide Continuum Individual

record

CONTINUUM OF CARE(Tribal-Rural-Urban poor-Urban)

Urban Overall Poor

Institutional delivery 75% 53%Full immunisation 56% 31%Underweight children 39% 56%

CONTINUUM OF CARE(Vulnerable- Poor-All)

CONTINUUM OF CARE(Health-Nutrition-sensory stimulation-Sanitation)

Continuum of care(Intervention/strategy implementation)

Training

CONTINUUM OF CARE(Macro-Micro-Trace nutrients)

Maternal Nutrition – Birth weight

CONTINUUM OF CARE(Extension of strategy from child-mother)

CONTINUUM OF CARE(Supplement to behaviour change)

CONTINUUM OF CARE(Public to Private system)

Adoption of Common

evidence based protocols

Mother & Child friendly

hospitals

Thank you

THANK YOU