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Andhra Pradesh - Reproductive & Child health


Issue


The major challenge for Andhra Pradesh has been a stagnating IMR at 53/1000 Live Births (NFHS-3), with 70% contributed by Neonatal Mortality.  Rural / urban disparities, inter district disparities and inequity in access to health care contribute largely to the stagnating rates.

Hence a special emphasis has been given to improve rural / tribal health, and adolescent health with special focus on underserved SC/ST population groups.

The declining Immunization coverage rates of infants to 46% (NFHS-3) and resurgence of polio is the other area of concern.  The quality of public health services is not satisfactory, resulting in poor utilization of the Primary Health Care System especially for Emergency Care of women, newborns and children.

Keeping this in view, numerous interventions have been designed including large Public-private Partnerships to make health services more accessible and accountable to the public, improve the health infrastructure facilities and health services in the public institutions in the state and increasingly involve the private sector. 

Effective integration of health concerns with other determinants of health and decentralized management at the district level to effectively handle increased allocations and promote policies is still poor. 

Management of human resources, with high vacancy rates and turn-over is a area which needs strengthening.  Family and community practices especially in rural areas continue to be poor with no timely decision making to seek care and timely arrival at health facility for specialized care during complications.

Action

Largest health sector input to Medak district was on operationalising IMNCI (Integrated Management of Neonatal and Childhood Illness) clinical protocols in the community and the health facility.  2486 (95%) Health and Nutrition workers in the district are implementing IMNCI to ensure newborn and sick children receive quality health care. 

To improve Newborn care and survival UNICEF supplied 14 items of life saving new born care equipments to 4 FRUs and 10 items to  61 PHCs  of Medak. Staff Nurses of 24-hour PHCs  will be trained as   for Essential Obstetric and newborn Care.

Zinc and Low osmolar ORS was supplied to Medak district and all health and Nutrition workers trained in its use in diarrhoea case management.

In Warangal district the Neonatal and Maternal Mortality Rate Reduction Project was started in 2007 through a three pronged strategy addressing.

Improved performance of Primary health service providers (1500 trained so far), Strengthening of  Institutional level management of newborns, mothers and children through facility strengthening (Neonatal equipment supplied) and Improved community and house hold level practices of key behaviors.

Advocacy with the State government has resulted in IMNCI strategy implemented in Medak and Warangal districts to be scaled up in the state through the Indian Institute of Health and Family Welfare. 

An adaptation of the same has also been introduced through the home based management of newborns through the Women Health Volunteers (ASHA workers of the state. 

Support for Maternal and Perinatal death Inquiry and response (MAPEDIR) is being demonstrated at Medak to advocate for scale up in the whole state. UNICEF also networks with professional bodies like NNF/IAP/FOGSI for capacity building and strategic interventions for reduction of MMR/IMR.

Impact

IMNCI monitoring data from the district shows that by 2008 July 91% of the deliveries in the district were institutional.

Percentage of Institutional deliveries to total births. Jan to July 2008 in Medak district

Percentage of newborns visited within 24 hours from Jan 2007 to July 2008 in Medak district

Percentage of Newborns initiated breast feeding within 1 hour and day 1 in Medak district:baseline 2005 and midline 2008

 

 

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