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Karnataka - Reproductive & Child Health

Issue

Karnataka as a state has achieved improved health indicators over the past decades, with IMR at present standing at 43/1000 Live Births (NFHS-3), with Neonatal Mortality amounting to 66% of IMR.  However access and equity remain a challenge, with uneven access to quality public health facilities across the state, particularly in the northern districts of the state. 

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.  Effective integration of health concerns with other determinants of health like sanitation, hygiene, nutrition, safe water and gender is still poor.

There is poor decentralized management at the district level to effectively handle the increased allocations and promote policies that strengthen public health management and service delivery. 

Management of human resources, with high vacancy rates and turn-over is still an area which needs strengthening. There is shortage of specialists in the CEmONC centres, especially in the northern districts. The part time placement of locally available specialists has not been successful.  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 was in the focus district of Raichur on operationalising IMNCI (Integrated Management of Neonatal and Childhood Illness) clinical protocols in the community and the health facility.  2016 (100%) 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 life saving new born care equipments to all the FRUs, CHCs and 24-hour PHCs of Raichur district.  Staff Nurses and Medical Officers of 24-hour PHCs were trained in Essential newborn Care. 

Zinc and low osmolar ORS was supplied to Raichur district and all health and nutrition workers trained in its use in diarrhea case management.   Grade 3 and 4 malnourished children in the district (700) were screened, investigated and are being followed up at the community and facility level.
 
Advocacy with the State government based on the Raichur district implementation has resulted in IMNCI strategy being scaled up in nine districts  through the NRHM/RHC2 funds.   Support for Maternal and Perinatal death Inquiry and response (MAPEDIR) was  also demonstrated in Raichur district with   advocacy 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 the percentage of newborns visited by health or nutrition workers within 24 hours of birth from Jan 2007 to March 2008 in Raichur district has remained between 70 to 74%.

The percentage of Newborns initiated on breast feeding within 1 hour in Raichur district has also increased from the 35.5%  in 2005 to 43.2% in 2008; and those started on breastfeeding on day 1 has increased from 50.3% to 98.6% during the same period.

Percentage of children receiving DPT, Measles and fully immunized in Raichur district has also increased between 2005 and 2008.

 

 

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