RCH Programme Child health and Immunization Issues and Way Forward - PowerPoint PPT Presentation

RCH Programme Child health and Immunization Issues and Way Forward Vigyan Bhawan New Delhi Dr. Rakesh Kumar Joint Secretary (RCH) Ministry of Health & Family Welfare Government of India

Current Status (All India) RCH II GOAL ALL INDIA STATUS RCH goal INDICATOR (Source of data) (2012) MMR 301 254 212 <100 (SRS 2007-09) (SRS 2001-03) (SRS 2004-06) IMR 60 53 44 <30 (SRS 2003) (SRS 2008) (SRS 2011) TFR 3.0 2.6 2.5 2.1 (SRS 2003) (SRS 2008) (SRS 2010)  Fifteen states and UTs have achieved the national target for IMR  21 states and UTs have achieved national target for TFR.  Only Kerala and Tamilnadu have achieved all 3 targets , including MMR. 2

Situation of Child Health in India (SRS 2004 - 2011) 80 74 Deaths per 1000 live births 69 U5M rate 70 64 IMR 59 58 58 57 60 55 53 50 47 50 44 NMR 37 37 37 40 36 35 34 33 30 29 28 28 27 27 26 25 Early NMR 20 2004 2005 2006 2007 2008 2009 2010 2011 India’s U5MR has declined much faster than the global average: from 118 in 1990 to 59 in 2010, the corresponding global average being 86 and 57 respectively. Further, during 2008- 10, India’s decline in U5MR has accelerated.

Status of IMR across states IMR decline (2010-2011) Name of the States/UTs 4 points decline Bihar, Haryana, Odisha, Punjab, Uttar Pradesh, Sikkim 3 points decline Andhra Pradesh, Assam, Chhattisgarh, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Manipur, Meghalaya, Mizoram, Dadra & Nagar Haveli, Pondicherry 2 points decline Andaman & Nicobar Islands, Chandigarh, Delhi, Himachal Pradesh, Jammu & Kashmir, Nagaland, Tamil Nadu, Uttarakhand, 0-1 point decline Daman & Diu, Kerala, Lakshadweep Increase in IMR Arunachal Pradesh, Goa, Tripura, West Bengal 70 59 57 57 55 52 52 IMR per 1000 live births 60 48 50 44 44 44 43 41 41 39 38 36 35 35 34 32 32 30 29 28 26 25 24 23 22 22 21 20 19 State wise IMR, SRS 2011 40 30 20 12 11 11 10 0 Madhya Pradesh Assam Chhattisgarh India Jammu & Kashmir Jharkhand Uttaranchal D & N Haveli West Bengal A & N Islands Odisha Uttar Pradesh Rajasthan Meghalaya Bihar Haryana Andhra Pradesh Gujarat Himachal Pradesh Karnataka Mizoram Arunachal Pradesh Punjab Tripura Delhi Sikkim Maharashtra Lakshadweep Tamil Nadu Daman & Diu Nagaland Chandigarh Pudducherry Kerala Goa Manipur

Thrust Areas for Reducing Child Mortality in India Immunisation Malnutrition 34% Reducing deaths due to Diarrhoea and ARI Addressing Under Reducing Neonatal nutrition Mortality

State specific Progress : Thrust area No. 1 - Neonatal Health Newborn care corner at each delivery point • Make one special newborn care unit functional in each district • Cover all newborn babies for first 6 weeks of life through Home Based Newborn Care • Issues States/UTs Training of NSSK (< 75%) All States/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and Odisha Andhra Pradesh (33.4%), Uttar P (39%), Madhya P (29%), Low Birth weight babies > Jharkhand (36%), Rajasthan (36%), Uttarakhand (28%), Assam 21% (National average) (26%) Source: HMIS 2011-12 Slow progress in Manipur, Tripura, Sikkim, West Bengal, Bihar, Chhattisgarh, Uttar establishment of SNCU (< Pradesh, J & K, Himachal Pradesh, Punjab, Haryana, Andhra 50% against target) Pradesh, Lakshadweep Training of ASHA module Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, 6 & 7 (< 50% in round 1) Maharashtra, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, West Bengal Home Based Newborn Home visits yet to start in all states except Chhattisgarh, Care Haryana, Gujarat, Karnataka, Maharashtra, Uttarakhand, Mizoram, Meghalaya, Sikkim , Tripura, Daman & Diu

State specific Progress : Thrust area No. 2 - Nutrition Promotion of optimal infant & young child feeding is the most important preventive • measure against child malnutrition Universal Iron folic acid supplementation is a prophylactic measure against anaemia. • Intervention States Tripura (7.1%), Jharkhand (15.6%), Uttar Pradesh (15.6%), Punjab Breastfeeding with in 1 hr. (16.4%), Bihar (16.5%), Jammu & Kashmir (20.4%), Uttarakhand (National Average: 33.5%; CES (24.9%), Andhra Pradesh (27.2%), Rajasthan (27.7%), Delhi 2009) (28.5%), West Bengal (29.2%), Madhya Pradesh (31.2%), Nagaland (27.8%), Arunachal Pradesh (36.5%), Madhya Pradesh (43.2%), Bihar (47%), Manipur (47.5%), Uttar Pradesh (48.2%), Vitamin A 1st Dose administration Haryana (49.9%), Haryana (49.9%), Tamil Nadu (50.3%), less than 60% (National Average; Meghalaya (51.3%), Jammu & Kashmir (53.4%), Gujarat (57.7%), Source: CES 2009) Rajasthan (58.5%), Chhattisgarh (58.8%), Sikkim (58.9%), UTs combined Iron Folic Acid Supplementation Assam (28%), Bihar (29%), Jharkhand (14%),Madhya Pradesh less than 40% in all states (data (25%), Chhattisgarh(38%), Odisha (23%),Rajasthan (9%), Uttar available only for 9 states: AHS Pradesh (10%), Uttarakhand (14%) 2011)

State specific Progress : Thrust area No. 3 – Diarrhoea and Pneumonia Community and facility based management of Diarrhea and Pneumonia is a priority • Two major killers of child hood: promote infant and young child feeding practices • through the health system and home based newborn care Intervention States Uttarakhand (17.6%), Uttar Pradesh (29.2%), Jharkhand (39.4%), Bihar ORT /ORS use < 53.6% (National (40.4%), Madhya Pradesh (45.9%), Rajasthan (48.9%), West Bengal Average:53.6%; Source: CES 2009) (49.9%), Punjab (53.3%) Nagaland ( 50.6%), Arunachal Pradesh ( 64.5%), Jharkhand ( 70.9%), Care seeking during ARI <75% (National Average:82.6%; CES 2009) Uttar Pradesh ( 72.3%) Haryana (35.40%), Karnataka (32.20%), Assam (31.40%), Sikkim (25.00%), Puducherry (24.10%), Mizoram (22.30%), Tripura (22.20%), Bihar (18.60%), Jharkhand (17.60%), Uttar Pradesh (17.50%), Maharashtra (9.10%), A & N Islands (7.00%), Arunachal Pradesh (6.40%), Andhra Pradesh (5.70%), Dadra & Nagar Haveli (5.40%), Gujarat F-IMNCI trained manpower < 35% (4.70%), Punjab (4.50%), Uttarakhand (2.60%), Meghalaya (1.20%), Himachal Pradesh (0.40%), Rajasthan (0.40%), West Bengal (0.40%), Chhattisgarh , Manipur , Nagaland , Tamil Nadu , Daman & Diu , Delhi , Lakshadweep :No trainings held

Routine Immunization State Specific Progress : Thrust area No. 4 - Immunization States with Low Performance DPT3 Coverage Uttar Pradesh, Assam, Puducherry, West Bengal, Karnataka, (<50%) Chhattisgarh, Arunachal Pradesh, Sikkim, Uttarakhand Hepatitis -B birth dose (<15% Meghalaya, Rajasthan, Karnataka, Lakshadweep, Himachal coverage) Pradesh, Manipur, Maharashtra, Jharkhand, Chhattisgarh, Assam, Haryana, Uttar Pradesh, West Bengal, Gujarat, Arunachal Pradesh, Mizoram, Tamil Nadu, Sikkim, Uttarakhand DPT1- DPT 3 drop out (>10% Puducherry, Lakshadweep, Meghalaya, Daman & Diu, Uttarakhand children ) Planned sessions missed Meghalaya, Uttar Pradesh, Tamilnadu, Maharashtra, Manipur, (>10%) Arunachal Pradesh Measles 2nd Dose (<15% Karnataka, Andhra Pradesh, Tamil Nadu, Uttarakhand coverage Non-SIA states) 9

Polio, Measles, JE, AEFI Missed Children in Polio NID – Nagaland, Arunachal Pradesh, Goa, Chhattisgarh, April 2012 (>7%) Jharkhand, Madhya Pradesh, Mizoram, Gujarat, Rajasthan Measles SIA Phase III Uttar Pradesh, Bihar, MP ( Final dates awaited) JE vaccination under RI (<20% Arunachal Pradesh, Karnataka, West Bengal, Assam, Tamil coverage) Nadu, Manipur, Uttarakhand Bihar, Jharkhand, Mizoram, Nagaland, Uttar Pradesh, Sickness Rate (>5%) Manipur Arunachal P, Himachal Pradesh, Jammu & Kashmir, States with NO AEFI reported Jharkhand, Manipur, Meghalaya, Mizoram, Nagaland, in 2012 Puducherry, Sikkim HMIS: April-July 2012

Measles Catch-up Campaign Special Campaign to vaccinate all children between 9 month-10 years of age with measles vaccine initiated in 14 low performing states • Phase I (2010-11) -45 districts in 13 states- 1.2 crore children vaccinated (87.22%) • Phase II (2011-12) -152 districts in 14 states- 3.6 crore children vaccinated (89.34%) • Phase III (2012-13) -currently ongoing in 167 districts in 5 states targeting ~8 crore children- Rajasthan, Madhya Pradesh, Uttar Pradesh, Gujarat and Bihar Issues Key actionable points Involvement of Private schools • • Education Department to be part of the campaign specially in Urban Areas • Missed out children in peri-urban • Dept. of WCD to actively involve Anganwari Workers in the slums Programme • Low awareness generation among • IEC bureau of the State to develop and implement a complete public related to the campaign IEC plan for the campaign Incorporation of Measles 2 nd dose • States to incorporate 2 nd dose under RI after 6 months of • under Routine Immunization campaign Media management in case of A media workshop should be organized in each district and • • adverse event state to nominate a spokesperson for any such event