UNICEF Action on Health
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© UNICEF India |
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A mother and child interact with one another. |
The Indian Challenge for Child Survival
Today, the Indian infant mortality rate is 55 per 1,000 live births. The under-five mortality rate is estimated at 75 per 1,000 live births.
Major investments in child health in India have not yet yielded substantial decline in maternal, infant and young child mortality in the recent decade. Importantly, the current neonatal mortality rate accounts for nearly two-thirds of all infant mortality and half of under-five child mortality.
These facts point to two inescapable conclusions:
1) India must accelerate efforts to reduce infant and child mortality and 2) these effort must give particular attention to reducing neonatal morality. UNICEF supports the national Reproductive and Child Health (RCH) programme in its aim to reduce maternal, neonatal and child mortality by improving healthcare services for communities.
In this context, it must be appreciated that mortality is not a burden equally shared across the country. Just four states, Madhya Pradesh, Rajasthan, Uttar Pradesh and Orissa account for more than 50% of infant deaths in India.
Four more states account for another 21%, or a cumulative 72%. Overall, the infant mortality rate would reduce by 50% if the rates in these eight poor states were brought down to the level of those in better performing states.
Underlying Causes of Infant and Child Mortality
The major causes of neonatal death in India resemble the global picture with infections (e.g. pneumonia, sepsis, and diarrhoea), prematurity and asphyxia as the leading causes.
About a third of all neonatal deaths occur on the first day of life. Approximately an additional one third of deaths occur between the first and seventh day of life.
National Rural Health Mission
Under the National Rural Health Mission (NRHM) (2005-2012), India proposes a bold approach to meet the MDG challenges for health.
Working for an ‘architectural correction’ of the public healthcare system, the NRHM aims to decentralise health planning and implementation to the district level. This also involves simultaneously pushing for convergence not only among traditionally vertical health programmes (Reproductive and Child Health Programme, Immunization, Malaria Control, TB Control, etc.) but also with other government departments.
In addition to greater synergy between health and nutrition, the new strategy embraces, more than ever before, the involvement of local government elected representatives, community based groups such as women’s self help groups, private practice and non-government organisations.
Coupled with a plan to effectively triple expenditure from 0.9% to 2-3% of GDP the strategy is strongly funded. UNICEF plays a critical roll to ensure the effective implementation of the NRHM, advocating at a national level for evidence based policies and strategies, bringing technical assistance at district and grass-roots.
UNICEF Programme and Policy Support
UNICEF plays a critical roll to ensure the effective implementation of the NRHM. UNICEFRight from advocating at a national level for evidence based policies and strategies to bringing technical assistance at district and grass-roots, ensuring capacity building and introducing technical innovations for expanding coverage effectively, and providing evidence and documentation of what works and what doesn’t to further refine national and state specific implementation policies.
UNICEF also works to promote interaction and convergence of actions across different social sectors. The following highlights some specific programming activities:
Integrated Management of Neonatal and Childhood Illnesses (IMNCI).
The global Integrated Management of Childhood Illnesses (IMCI) clinical package developed by WHO and UNICEF has been adapted to include neonatal care and home visitation being rolled out in India.
The overall package focuses on the newborn and the under-three child. It promotes home visiting, care at birth, counselling, as well as identification, classification, and treatment of main illnesses with standard protocols by expanding service delivery to village level and by enhancing the skills of village workers (“Anganwadi workers”) and community health workers (“Auxiliary Nurse-midwifes”).
The programme has demonstrated the effectiveness of a mix of community and health facility based activities to improve newborn care practices at home; exclusive breastfeeding; care-seeking during illness; referrals; and appropriate and prompt treatment during illness.
Importantly, IMNCI is a central element of the National Reproductive and Child Health programme.
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© UNICEF India |
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An expectant mother. |
Immunization
Immunization is one of the most cost effective public health interventions available. Yet, a large proportion of vulnerable infants and children in India are not receiving this simple intervention. Across India in 2006-07, only 62% of children 12-23 months had received all six of their primary vaccines, with a wide variation among states (Coverage evaluation survey 2006).
States with poorer immunization rates are generally the same states with higher infant mortality. India also has the largest number of infants who reach their first birthday not fully immunized. Improving routine immunization rates and immunization of incoming newborns’ cohorts will continue to be a decisive element of the overall strategy.
UNICEF provides support for national and state level policy and planning. In addition, UNICEF supports in vaccine and cold chain management, procurement, supplies and capacity building of health workers, cold chain handlers and program managers.
ORS / Zinc Therapy for Diarrhoea
After several years of advocacy and efficacy research on the critical benefit of ORS with adjunct zinc therapy for children suffering from diarrhoea, India has recently adopted policy to introduce zinc with ORS in the management of all cases of childhood diarrhoea in line with WHO/UNICEF recommendations. The policy shift offers a vital opportunity for saving the lives of children, but must gain momentum to be quickly and effectively rolled-out.
Special Care Newborn Units (SNCU)
With the renewed thrust on institutional deliveries as a part of the Government of India’s flagship health programme, the National Rural Health Mission, a rapidly increasing proportion of newborns are being delivered in hospitals.
In addition, the roll-out of IMNCI is leading to significant jump in timely identification and referral of sick newborns to facilities which must provide life saving services. This unit provides high quality skilled care to premature / ill neonates by offering facilities for continuous monitoring and use of life support systems with the aim of improving survival of these babies.
Maternal and Perinatal Death Inquiry and Response (MAPEDIR)
The Maternal and Perinatal Death Inquiry and Response (MAPEDIR) is a verbal autopsy tool that collects the vital information essential to address maternal and perinatal mortality. This community-based death inquiry builds awareness of the causes of maternal and peri-natal deaths, and facilitates the strengthening of health systems through advocacy for a better response to maternal deaths.
