Mother and Child Health: Status, Challenges and Way Forward · Siddharth Agarwal (2005). Mother and Child Health: Status, Challenges and Way Forward. Presentation made at 3rd India

Mother and Child Health: Status, Challenges and Way Forward

3rd India Health Summit, Hyatt Regency, New Delhi21-22 November, 2005

Dr. Siddharth AgarwalUrban Health Resource Centre [formerly EHP India]

Siddharth Agarwal (2005). Mother and Child Health: Status, Challenges and Way Forward. Presentation made at 3rd India Health Summit organized by CII and Indian Healthcare Federation. New Delhi, November 21-23,2005

Over view of the presentation

• Status of Mother and Child Health in India

• Operational Challenges

• Suggestions for Way Forward


Status of Mother and Child Health in India


Maternal and Child Mortality in India

25%0.13 millionMaternal deaths

Proportion of globalEstimated NumbersAnnual Mortality

22%2.4 millionChild deaths

24%1.7 millionInfant deaths

30%1.2 millionNeonatal deaths

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)


123

10494 87

0

20

40

60

80

100

120

140

1990 1995 2000 2003 2015

Years

U-5

MR

41

Source: http://globalis.gvu.unu.edu/indicator_detail.cfm?IndicatorID=26&Country=IN accessed on 20th Oct, 2005

*

* MDG

Concerted efforts in mission mode are needed if India is to achieve MDG

http://globalis.gvu.unu.edu/indicator_detail.cfm?IndicatorID=26&Country=IN


Causes of Maternal Deaths

24%

23%

12%

10%

10%

7%

14%

Source: Registrar General India, Survey of Causes of Death,1998

Half the maternal deaths are directly or indirectly contributed by anemia

Anemia

Hemorrhage

Abortion

Sepsis

Toxemia

Mal-position

Others


Causes of Infant Deaths

Source: SRS 1998

Over 70% of infant deaths are preventable through inexpensive and many through home based care


0

20

40

60

80

100

Malnourished(< 2 SD)

Anemia amongwomen

Average

47 52

Source: International Institute for Population Sciences (IIPS) and ORC Macro. 2000. National Family Health Survey (NFHS-2), 1998-99; India. Mumbai: IIPS

Every second child is undernourished

Nutrition status

Every second woman is anemic


42


0

25

50

75

100

ANC+TT+IFA

Institutional deliveries

20

34

Poor coverage of essential MCH services

Service Coverage

Complete Immunization of children


Socio-economic Differentials in Child Mortality

0

30

60

90

120

150

U-5 MR

95103

63

112


Average data masks the real Child health Scenario among the poor (one-thirds of India’s population)

0

100

Home deliveries

66

34

7480

Average Average-R Average-U Poor


Regional differences in IMR

0

30

60

90

120

150

IMR

KeralaHPGoaAverageMPUPMeghalaya

16

34 37

67

8687 89


Infant and Child survival substantially lower in EAG or BIMARU states (40% population) and NE states


0

20

40

60

80

100

020406080

100120140160

Under 5 Mortality * Infant Mortality * Neonatal Mortality *

Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages

[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]

103.7

46.7

Rural Average

103.7

63.147

73.3

31.7

49.638.4

Urban Average Urban Poor

101.3

66

39.1

56.0

Nutritional Status

* Mortality per 1000 live births

Child Health and Survival in Urban slums


51.34 Total

21.27 Urban

HIV estimates 2004(in lakhs)

30.07

Rural

Source: http://www.nacoonline.org/facts_hivestimates.htm, Accessed on 20th Nov, 2005

High risk of transmission from infected parents to children during pregnancy, delivery and breastfeeding

High Prevalence of HIV/AIDS

http://www.nacoonline.org/facts_hivestimates.htm


What are the challenges in addressing compromised MCH scenario in our

country?


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


Challenge # 2

Weak Demand Among Poor Communities

• Low awareness about services, behaviours and provisions

• Weak capacity to negotiate for MCH services


Challenge # 3Gender Inequity

• Low awareness and compromised confidence among women to assert for and obtain needed health care

• Insufficient family support to women


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


•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

Challenge # 5 Urban Poor Mother and Child largely neglected


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


Suggestions for the Way Forward


Action Point # 1Strengthen 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)


DELIVERY-28 days: safe delivery, EBF, immunization

PREGNANCY : TT, IFA, de-worming, diet, EBF, birth preparation

0-6 months: EBF, OPV, BCG, DPT

12-24 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.)

Key Contacts in Lifecycle for Delivering the Package

6-12 months: appropriate CF & SNP at AWC (frequency, amt active feeding, illness), measles vaccination, vitamin A, iron supplements


Action Point # 2Reach 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


Community Health Funds

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


Nutritional Gardening


Action point # 3Enable 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


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

Action point # 4Public Private Partnership


Government

1.Vaccine2.Other supp.3.Coordination

A possible PPP Approach Bringing Health Services to Un-reached Areas

Corporate & NGO

Spo nsored by:Company... .... .

Referral to Identified FRUs/Charitable Trust

Several Private agencies operates mobile health care vans to reach unreached populations

Outreach

10,000

Outreach

10,000

Outreach

10,000


Nodal Govt./Municipal Dispensary

1.Vaccines2.Other supplies3.Coordination

2nd tier Govt./Private Centre

Village 2

3000 popln

Village 3

3000 popln

Village 4

3000 popln

Week 2

Week 4

Village 1

3000 poplnWeek 1

Another possible PPP Approach Part-time Outreach Services by Private Doctors

Week 3

Under the govt. immunization scheme there is provision of Rs. 1400 for 4 camps to be held in a village/slum per month

Referral from slums to Govt. Dispensaries or 2nd tier Govt/Private centre

Socially Committed Private Doctor[receives honorarium from Govt]

(about 3-4 hrs every Sunday)

District NRHM/RCH Unit Coordinates with private doctors, NGOs, nodal Dispensary,Coordinates periodic review

Social Mobilization by NGO• Identifies and trains health volunteers• Supports community mobilization• Supports outreach services• Builds linkage between community, health providers


• 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

Action point # 5 Corporate Social Responsibility for MCH


A possible Approach Corporate Partnership with Govt for expanding services

CSR In-charge

MCH Service Team

Residents+nurse

Social Mobilizer[Full time]

Socially committed Corporate Hospital

Community 2

4000 popln

Community 3

4000 popln

Community 4

4000 popln

Community1

4000 popln

Nodal Government Health Facility

(1st Tier Centre)

Private / Govt. 2nd tier health center

VaccinesSupplies

Referral supportCoordination

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

Reporting

Referrals to Govt. Dispensary and 2nd tier Govt/Private Centre

Outreach services include treatment of minor illnesses, ANC, immunization, health counseling


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


• 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

Action point # 7 Partner effectively with Media

An important collaborator for awareness and change


Action point # 8Develop 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


Action Point # 9Translate 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 HealthTime is Essence in Public Health

We cannot waitWe cannot wait


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

Documents

Mother and Child Health: Status, Challenges and Way Forward · Siddharth Agarwal (2005). Mother and Child Health: Status, Challenges and Way Forward. Presentation made at 3rd India