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 INDICATOR ALL INDIA STATUS (Source of data) RCH goal (2012)

MMR 301 (SRS 2001-03) 254 (SRS 2004-06) 212

(SRS 2007-09)

<100 IMR 60 (SRS 2003) 53 (SRS 2008) 44 (SRS 2011) <30 TFR 3.0 (SRS 2003) 2.6 (SRS 2008) 2.5 (SRS 2010) 2.1

• 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.

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Situation of Child Health in India (SRS 2004 - 2011)

74 69 64 59 58 58 57 55 53 50 47 44 37 37 37 36 35 34 33 26 28 28 29 27 27 25 20 30 40 50 60 70 80 2004 2005 2006 2007 2008 2009 2010 2011 Deaths per 1000 live births NMR Early NMR U5M rate

IMR 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

59 57 57 55 52 52 48 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 12 11 11

10 20 30 40 50 60 70

Madhya Pradesh Odisha Uttar Pradesh Assam Rajasthan Meghalaya Chhattisgarh Bihar Haryana India Andhra Pradesh Gujarat Jammu & Kashmir Jharkhand Himachal Pradesh Uttaranchal Karnataka D & N Haveli Mizoram West Bengal Arunachal Pradesh Punjab Tripura Delhi Sikkim Maharashtra Lakshadweep A & N Islands Tamil Nadu Daman & Diu Nagaland Chandigarh Pudducherry Kerala Goa Manipur

IMR per 1000 live births State wise IMR, SRS 2011

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

Thrust Areas for Reducing Child Mortality in India

Malnutrition 34%

Reducing Neonatal Mortality Addressing Under nutrition

Reducing deaths due to Diarrhoea and ARI

Immunisation

Issues States/UTs Training of NSSK (< 75%) All States/UTs except Arunachal Pradesh, Goa, Madhya Pradesh, Nagaland and Odisha Low Birth weight babies > 21% (National average) Andhra Pradesh (33.4%), Uttar P (39%), Madhya P (29%), Jharkhand (36%), Rajasthan (36%), Uttarakhand (28%), Assam (26%) Source: HMIS 2011-12 Slow progress in establishment of SNCU (< 50% against target) Manipur, Tripura, Sikkim, West Bengal, Bihar, Chhattisgarh, Uttar Pradesh, J & K, Himachal Pradesh, Punjab, Haryana, Andhra Pradesh, Lakshadweep Training of ASHA module 6 & 7 (< 50% in round 1) Andhra Pradesh, Assam, Bihar, HP, J & K, Jharkhand, Maharashtra, Madhya Pradesh, Punjab, Rajasthan, Uttar Pradesh, West Bengal Home Based Newborn Care Home visits yet to start in all states except Chhattisgarh, Haryana, Gujarat, Karnataka, Maharashtra, Uttarakhand, Mizoram, Meghalaya, Sikkim , Tripura, Daman & Diu

• 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

State specific Progress : Thrust area No. 1 - Neonatal Health

Intervention States Breastfeeding with in 1 hr. (National Average: 33.5%; CES 2009) Tripura (7.1%), Jharkhand (15.6%), Uttar Pradesh (15.6%), Punjab (16.4%), Bihar (16.5%), Jammu & Kashmir (20.4%), Uttarakhand (24.9%), Andhra Pradesh (27.2%), Rajasthan (27.7%), Delhi (28.5%), West Bengal (29.2%), Madhya Pradesh (31.2%), Vitamin A 1st Dose administration less than 60% (National Average; Source: CES 2009) Nagaland (27.8%), Arunachal Pradesh (36.5%), Madhya Pradesh (43.2%), Bihar (47%), Manipur (47.5%), Uttar Pradesh (48.2%), Haryana (49.9%), Haryana (49.9%), Tamil Nadu (50.3%), Meghalaya (51.3%), Jammu & Kashmir (53.4%), Gujarat (57.7%), Rajasthan (58.5%), Chhattisgarh (58.8%), Sikkim (58.9%), UTs combined Iron Folic Acid Supplementation less than 40% in all states (data available only for 9 states: AHS 2011) Assam (28%), Bihar (29%), Jharkhand (14%),Madhya Pradesh (25%), Chhattisgarh(38%), Odisha (23%),Rajasthan (9%), Uttar Pradesh (10%), Uttarakhand (14%)

• 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.

State specific Progress : Thrust area No. 2 - Nutrition

Intervention

States

ORT /ORS use < 53.6% (National Average:53.6%; Source: CES 2009)

Uttarakhand (17.6%), Uttar Pradesh (29.2%), Jharkhand (39.4%), Bihar (40.4%), Madhya Pradesh (45.9%), Rajasthan (48.9%), West Bengal (49.9%), Punjab (53.3%)

Care seeking during ARI <75% (National Average:82.6%; CES 2009)

Nagaland ( 50.6%), Arunachal Pradesh ( 64.5%), Jharkhand ( 70.9%), Uttar Pradesh ( 72.3%)

F-IMNCI trained manpower < 35%

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 (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

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

Routine Immunization States with Low Performance

DPT3 Coverage (<50%) Uttar Pradesh, Assam, Puducherry, West Bengal, Karnataka, Chhattisgarh, Arunachal Pradesh, Sikkim, Uttarakhand Hepatitis -B birth dose (<15% coverage) Meghalaya, Rajasthan, Karnataka, Lakshadweep, Himachal 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% children ) Puducherry, Lakshadweep, Meghalaya, Daman & Diu, Uttarakhand Planned sessions missed (>10%) Meghalaya, Uttar Pradesh, Tamilnadu, Maharashtra, Manipur, Arunachal Pradesh Measles 2nd Dose (<15% coverage Non-SIA states) Karnataka, Andhra Pradesh, Tamil Nadu, Uttarakhand

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State Specific Progress : Thrust area No. 4 - Immunization

Polio, Measles, JE, AEFI

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

HMIS: April-July 2012

Measles Catch-up Campaign

Issues Key actionable points

• Involvement of Private schools

specially in Urban Areas

• Education Department to be part of the campaign
• Missed out children in peri-urban

slums

• Dept. of WCD to actively involve Anganwari Workers in the

Programme

• Low awareness generation among

public related to the campaign

• IEC bureau of the State to develop and implement a complete

IEC plan for the campaign

• Incorporation of Measles 2nd dose

under Routine Immunization

• States to incorporate 2nd dose under RI after 6 months of

campaign

• Media management in case of

adverse event

• A media workshop should be organized in each district and

state to nominate a spokesperson for any such event

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

• 113 JE endemic districts in 15 states conducted JE vaccination

campaign from 2006-2010

• JE vaccination now part of routine immunization in all 113 districts
• 62 new JE endemic districts identified for campaign in 2012-13 and

2013-14

Japanese Encephalitis (JE) Vaccination

Issues Key actionable points Low coverage of JE vaccine under Routine Immunization

• JE vaccination to be streamlined under RI
• Regular monitoring of JE coverage
• Updation of Micro plan and training of

vaccinators

• Vaccine stock management to ensure vaccine

availability at each session site

Planned Campaign in selected districts

• f Bihar, Assam, Nagaland, West Bengal

and Jharkhand in 2012-13

• States to prepare for upcoming campaign

Intensification of RI “Year 2012-13”

Completed (8 states)

• Gujarat, Madhya Pradesh, Rajasthan, UP,

Arunachal Pradesh, Manipur, Nagaland, Tripura

On going (10 states)

• Bihar, Chhattisgarh, Jharkhand, Orissa,

Uttrakhand, Meghalaya, Karnataka, Punjab, Himachal Pradesh, Orissa

Planned (5 states)

• West Bengal, J&K, Haryana, Kerala ,

Mizoram

Inadequate Supervision

• Implement revised Routine immunization

monitoring strategy and measure monthly progress

Weak program Visibility (IEC)

• Develop state specific comprehensive IEC plan
• Concept of using Tracking bags for ANC and

children.

Shortage of HR & Urban area micro planning

• Fill vacant positions of ANMs & MOs esp. in High

Focussed Districts

• Develop strategic plan to reach the unreached

ISSUES

3 states (Tamil Nadu, Andhra Pradesh and Sikkim) - yet to plan Immunization weeks

Immunization weeks update ACTION POINTS

BCG DPT Measles JE Hep B OPV TT 8.38 31.26 9.95 3.47 23.05 33.04 14.86 Antigen wise coverage in lakhs (as on 26 Oct 2012)

Thank you