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The picture in India
India is faced with an
unparalleled child survival and health challenge. The country contributes
2.38 million of the global burden of 10.8 million under-five child deaths,
which is the highest for any nation in the world. Nearly 26 million infants are born each
year, of whom 1.2 million die before completion the
first 4 weeks of life and 1.7 million die before reaching the first birthday.
The Infant Morality Rate (IMR)
in India
has declined from 114/1000 live births in 1980 to 58 in 2004(SRS data).There
are however wide variations amongst and within the states in infant and child
mortality. In 2004, while Kerala
recorded an IMR to 12/1000 live births, in the same year the IMR in Madhya
Pradesh were 79/1000. The other states
with an IMR significantly above the national average of 58/1000 live birth
are Orissa (77), UP (72), Rajasthan (67) and Assam (66) (SRS 2004).
Causes of
childhood mortality
The major killers of children
are – acute respiratory infections, dehydration due to diarrhea, measles and
neonatal tetanus and in some areas malaria.
The high prevalence of malnutrition contributes to over 50% of child
deaths. In India, a significant proportion of child deaths (over 40% of
under-five Mortality and 64% of infant mortality) take place in the neonatal
period. Apart from infections, other
causes like asphyxia, hypothermia and pre-maturity are responsible for
neonatal mortality. About one-third of the newborns have a birth weight less
than 2500 gram (low-birth weight). A significant proportion of mortality
occurs in low-birth weight babies. It has been recognized that further
reduction of IMR will require focused attention on Neonatal mortality.
Strategy for
child health in RCH II
A two pronged strategy for
child health is proposed in RCH II.
 Strengthening existing child health services
 Essential
newborn care (Breast feeding, warmth, Hygiene, cord care and recognition of
danger signs)
Immunization
Skilled
care at and after birth
Control
of diarrhoeal diseases and ARI
Breastfeeding
and complementary feeding
Micronutrient supplementation (Vitamin A, Iron)
Introducing Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)
The
Government of India recognizes that IMNCI is a superior approach to newborn
and child survival and health. IMNCI
implementation would integrate, build on and improve quality of the existing
approaches for diarrhoeal disease, ARI and malaria
treatment. It brings health and
nutrition interventions (breastfeeding, complementary feeding, vitamin A
supplementation, care of the severely malnourished) together into one
package. More significantly, it not
only includes care of sick neonates, but also incorporates care of all
neonates in the home settings through home visits by health workers to
address neonatal survival and health.
It also reinforces continuum of care from the household and community
level to the facility level.
WHO technical assistance for Child Health:
Technical
assistance for Child Health Strategy in RCH-II:
Sustained advocacy by WHO for appropriate strategy
for child health has resulted in the inclusion of Integrated Management of
Newborn and Childhood Illnesses (IMNCI) as the central Child Health Strategy
under RCH–II.
Adaptation
of IMCI to IMNCI:
Given the fact that majority of the infant deaths
occur in the first week of birth, the “Integrated
Management of Childhood Illnesses (IMCI)” was adapted to include the
care of children from 0-7 days renaming it as IMNCI where “N” is for newborn
care. WHO supported this adaptation including pilot testing of the adapted material.
National
plan for implementation of IMNCI under RCH-II:
WHO in collaboration with GOI assisted hosting the
first National planning workshop at NIHFW in Jan 2005 where 11 states were
oriented on IMNCI and State plans for implementation of IMNCI were developed.
State Planning meetings on IMNCI
WHO provided assistance in
developing district plans for IMNCI implementation in the States of Gujarat,
UP, Haryana, Uttaranchal and Madhya Pradesh.
IMNCI
Operational plan under RCH-II/NRHM
WHO, India assisted the child health
division of the ministry of health and family welfare in the development of
National Operational Plan for IMNCI implementation under RCH-II/NRHM
Capacity
building for implementation of IMNCI:
WHO supported training of National level trainers
in IMNCI at the national nodal centres in New Delhi.
Pre service IMNCI
WHO supported pre service IMNCI
teaching as a part of Undergraduate medical education by providing assistance
in the development of teaching material and piloting in 4 medical colleges of
Mumbai, Bangalore, Bhopal
and Ludhiana.
To
scale up pre service IMNCI activities in the Country, a Technical Working
Group has been established by Government of India.
Evaluation of Pre service IMNCI
WHO supported evaluation of
IMNCI teaching in the 4 medical colleges where it was started as a pilot project. The report was shared in a meeting with
Additional Secretary Health Government of India. Based on the report the GOI
has written to States for starting Pre Service IMNCI in their institutions.
Expert Group Meeting at AIIMS For Scaling up IMNCI
Introduction in Undergraduate Curriculum
In order to share experiences
gained in the pre service IMNCI project and to envision nation-wide scaling
up of IMNCI in MBBS curriculum, this Expert Group Meeting was organized at
AIIMS on 5th and 6th November 2005, in collaboration with WHO India Office.
The strategy for accelerating Pre Service IMNCI implementation was formulated
in the meeting.
Accelerating Pre
service IMNCI implementation
WHO India is providing technical assistance for
accelerating IMNCI implementation in the teaching curricula of more
institutions.
Maharashtra
university of health Sciences with joint assistance of WHO
and UNICEF has already constituted a core group for implementation in the
institutions in its jurisdiction.
Rajiv Gandhi university in Karnataka has decided to
start teaching in the medical colleges. A workshop for this was organized in M.S.Ramaiah Medical College Bangalore where 4 other
medical colleges were trained with WHO Assistance.
Gujarat State Government has developed an implementation
plans in collaboration with WHO for starting Pre service IMNCI in 14
institutions.
Tamil Nadu is going to start Pre service IMNCI in
14 training institutions with WHO support.
IMNCI Training for IAP members
WHO provided technical
assistance in developing training material on IMNCI and assisted in capacity
building of IAP members
in partnership with UNICEF and IAP.
Alternate methods of IMNCI implementation
WHO provided assistance in the
training of trainers of Post Graduate Diploma in Maternal and Child Health in
collaboration with Indira Gandhi National Open
University (IGNOU) for capacity building on IMNCI.
Streamlining of micronutrient supplementation policy as
per IMNCI guidelines
In collaboration with GOI, ICMR
and expert groups; Iron, Vitamin A and Zinc supplementation guidelines are
being streamlined Per IMNCI.
District Newborn Care
In partnership with GOI and NNF
district teams were given training in 140 districts. In these districts
essential newborn care equipments had been supplied.
Guidelines for Medical officers on SBA
TA for care at birth in 24 hrs.
PHC and FRU was provided for developing guidelines.
Launch of Low osmolarity ORS
Low osmolarity
ORS was launched in India with WHO Technical assistance. This
follows the WHO-UNICEF Joint Statement on Clinical Management of Acute Diarrhoea.
On going technical assistance for
providing zinc as an adjunct to ORS in the treatment of diarrhoea in children
Technical assistance has been provided
for using Zinc as an adjunct therapy in addition to ORS for the treatment of acute diarrhoea in children. Government
of India has accepted these recommendations.
Development of Guidelines for managing Newborn and
childhood diseases during disasters
WHO in partnership with IAP
developed “Management of newborn and childhood diseases in disasters”
Training guidelines for ASHA
Technical assistance is being
provided to develop training guidelines for ASHA under NRHM
Vitamin A and IFA Supplementation
Technical
assistance has been provided by WHO.
Links:
WHO Headquarter website
WHO SEARO website
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