Nirogi Bal Varsh 2008-09

Current scenario

Infant Mortality in India …..a sensitive measure of social development India-57 Approximately 20% of the world’s children are in India and yet there is disproportionate share of human development problems – I.e. high maternal mortality, high levels of low birth weight and malnutrition and negative trends in other social/human development indicators such as child labour and sanitation. SRS 2006

Best performing state in India Where are we now? Key Indicators Gujarat Best performing state in India NPP 2010 MDG 2015 IMR 53 15 (Goa, Kerala) <30 27 NMR 33 8.8 (Goa) <20* U5MR 60.9 16.3 - 41 MMR 172 110 (Kerala) <100 Reference: IMR - SRS 2006 MMR -SRS 2001-2003

Slow decline in Infant Mortality 66% in first 7 days 62 R 53 T 37 U Goal 27 Source: SRS Wide difference in Rural and Urban areas

Sharp fall in child mortality rate (1-4 years) Faster decline in U5MR. The decline in IMR has not been as fast Slow rate of decline in the neonatal mortality Trends in neo-natal mortality, IMR and U5MR NFHS

WHO IS PROVIDING HEALTH CARE? NSSO 60TH ROUND

Nirogi bal varsh

Key components for the Nirogi Bal Varsh Care of the mother Right of the Girl child to be born Unmet need for Family Planning Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Inter departmental coordination

MMR Comparison with other states

“ Focus on 100% institutional delivery “ Two districts shall be soon “safe delivery district” (Mehsana & Gandhinagar)

183515 734 38 696 8809 753 8056 Outcome of Chiranjeevi Scheme: Mothers & New Born babies saved Total Deliveries under Chiranjeevi scheme Expected Maternal Death Maternal death reported under Chiranjeevi scheme Mothers saved under Chiranjeevi scheme Expected New born death New born death reported under Chiranjeevi scheme New born saved 183515 734 38 696 8809 753 8056 Normal Deliveries: 159871 C-Section: 11407 (6.22%) Complicated Deliveries: 12237 (6.67%) Private specialist enrolled: 862/2000

Gandhinagar Region Banaskantha Deodar Sabarkantha Amirgadh Danta Khedbrahma

Vadodara Region Bharuch Vagra Narmada Nandod Dediapada Sagbara Nasvadi Kawant Chota Udaipur Dahod Halol Panchmahal Ghoghamba

Bhavnagar Region Porbandar Ranavav Amreli Rajula Khambha Bhavnagar Palitana Talaja Sinor Vallabhipur Botad Junagadh Una Jafrabad

Rajkot Region Kutch Lakhpat Abdasa Nakhatrana Anjar Bhachau Rapar Jamnagar Kalyanpur Rajkot Maliyana Mia Jasdan

Surat Region Surat Mandvi Vyara Umarpada Uchchal Songadh Valsad Dharampur Kaprada

Ahmedabad Region Surendranagar Limbdi Muli Sayla

Key components for the Nirogi Bal Varsh Care of the mother Unmet need for Family Planning Right of the Girl child to be born Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Inter departmental coordination

TFR

Crude birth rate

Special Initiatives for NSVs in last three years

Key components for the Nirogi Bal Varsh Care of the mother Unmet need for Family Planning Right of the Girl child to be born Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Inter departmental coordination

Action taken against defaulters Details Nos. Seal & Seize 147 Court Cases 79 Cases in High Court of Gujarat 17 Sting Operation 03

Sex ratio at birth as per CRS records

State average: 870 (2006) Name of the Districts Sex Ratio -2004 Sex Improving Trend in Sex Ratio District Sex Ratio 2004 2005 2006 Ahmedabad 792 828 869 Amreli 805 850 842 Anand 840 821 886 Banaskantha 814 843 866 Bharuch 899 903 941 Bhavnagar 784 804 878 Gandhinagar 769 813 865 Junagadh 835 858 907 Mehsana 791 863 Narmada 892 917 962 Navsari 897 922 985 Panchmahal 834 965 Porbandar 846 872 Patan 833 880 Rajkot 800 796 831 Dang 924 951 938 Surendranagar 864 876 Sabarkantha 786 856 Vadodara 839 894 893 Valsad 915 968 1002 5 Districts showing deterioration in sex ratio Name of the Districts Sex Ratio -2004 Sex Ratio- 2005 Ratio- 2006 Surat 815 794 796 Kutch 877 930 920 Jamnagar 860 871 Kheda 830 904 878 State average: 870 (2006)

17 Talukas still showing deterioration in sex ratio Name of the Talukas Sex Ratio -2004 Sex Ratio- 2006 Ahmedabad City 850 818 Amreli 826 801 Kukavav Vadia 807 707 Bagasara 883 785 Anand 813 790 Sujitra 930 855 Petlad 849 779 Visnagar 789 Mehsana 814 774 Kadi 854 843 Chansama 758 751 Rajkot 852 773 Upleta 860 811 Jetpur 897 767 Dhoraji 842 832 Surat City 786 781 Wadhvan 865 815 13

Sex ratio of a private clinic followed over a period of time

Key components for the Nirogi Bal Varsh Care of the mother Unmet need for Family Planning Right of the Girl child to be born Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Inter departmental coordination

Anaemia in Gujarat Vegetarianism, wheat cereal based diet and very low intake of green leafy vegetables

Malnutrition Map of Gujarat Banaskantha Patan Sabarkantha Mehsana Kutch Gandhinagar Panchmahals Ahmedabad Dahod Kheda Surendranagar Anand Jamnagar Vadodara Rajkot Narmada Porbandar Bharuch Bhavnagar Amreli Surat Junagadh ≥ 50 % 40-49 % Navsari Dangs 30-39% 20-29% Valsad 46 Source : National Family Health Survey-III 05-06 46

Mal-nutrition Contributes A Large Share of Child Deaths Black et al. The Lancet 2003 ; 361: 2226-34

Consumption pattern of 4-6 yrs The latest NNMB data (2006-7) show that even today there is a deficit of over 500 calories in the intakes of 1-3 years old and about 700 calorie among the 3-6 years old (see below). There are bound to be additional multiple vitamin and mineral deficiencies when there is a 40% deficit in calories. It is, therefore, not surprising that the current nutrition supplements of 300 calories, consisting mainly of cereals, often fail to be reflected in better weights and heights of children (though their nutrition status might be even worse in the absence of these limited supplements). Source:- NNMB (04-05)

Consumption pattern of 1-3 yrs The latest NNMB data (2006-7) show that even today there is a deficit of over 500 calories in the intakes of 1-3 years old and about 700 calorie among the 3-6 years old (see below). There are bound to be additional multiple vitamin and mineral deficiencies when there is a 40% deficit in calories. It is, therefore, not surprising that the current nutrition supplements of 300 calories, consisting mainly of cereals, often fail to be reflected in better weights and heights of children (though their nutrition status might be even worse in the absence of these limited supplements). Source:- NNMB (04-05)

Protein & Calorie adequacy status Source:- NNMB (04-05). For Gujarat

Four priority result areas- to address high malnutrition 1. Early initiation and exclusive breastfeeding in the first 6 months of life Timely initiation of breastfeeding within 1 hour of birth Colostrum feeding in the first 3-4 days of life Exclusive breastfeeding in the first 6 months of life 2. Complementary feeding Timely introduction of complementary foods at 6 months Improved quality of complementary foods Improved feeding, hygiene, and sanitation practices UNICEF India will support GOI in the delivery at national scale of five priority interventions that are Evidence-based High-impact These priority interventions are delivered: At the right time: pregnancy and the first two years of life To the right children, starting with the most vulnerable In stark contrast with its impressive rates of economic growth in the past decade, India has one of the highest rates of child undernutrition in the world. Child undernutrition is an emergency that needs a revolutionary response. There is now enough epidemiological and programmatic evidence – both nationally and globally - to affirm that India could halve child undernutrition rates by focusing its human and financial resources in five priority results areas:

Four priority result areas (Conti…) 3. Micronutrient Supplementation Vitamin A supplements for all children 9-59 mo bi-annually in addition to dietary sources Iron/Folate supplementation Zn + ORS for all children with diarrhea 4. Evidence based management of children with severe acute malnutrition Community-based management Referral

Key components for the Nirogi Bal Varsh Care of the mother Unmet need for Family Planning Right of the Girl child to be born Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Inter departmental coordination

Neonatal Deaths Neonatal deaths are a major contributing factor to U5 mortality in India Under five deaths Neonatal deaths 37% 50% World India Source: PFC 2007 & SRS

Just Born !!!! Newborn period 31 deaths per month 5 10 15 20 25 30 35 The risk of dying is 15 times higher in the first month of life than in subsequent months of infancy Deaths per 1000 live births Post-neonatal period (1-11 months) 2 deaths per month Children (12-59 months) 1 death per month Average number of deaths per month in each period of a child’s life

Care of the neonate Care of the mother Hypothermia management Breast feeding Asphyxia Infections ARI

Given ORS to children during Diarrhoea=29.7 DLHS2003

Immunization Performance 2006-07 & 2007-08

Poor performing Blocks Gandhinagar Region District Block PHCs Patan Sami Baspa, Lolada, Mujpur, Shankheshwar Radhanpur Bandhvad, Gotarka, Nanapura Santalpur Abiyana, Madhutra, Varahi, Zazam Banaskantha Vadgam Chhapi, Jalorta, Kodram, Meta, Panchada, Pilucha Vav Asarevas, Dheema, Mavsari, Morwada, Suigam

Poor performing Blocks Vadodara Region District Block PHCs Vadodara Sinor Sadhal, Simali, Sinor Karjan Choranda, Methi, Valan Bharuch Valia Daheli, Gundia Narmada Nandod Lachhras, Jetpur, Garudeshwer Rajuvadia, Taropa, Jesalpor, Sisodra Dediapada Mandala Sagbara Kolvan, Selmba Tilakwada Vajiria, Agar, Bujetha

Poor performing Blocks District Block PHCs Valsad Pardi Balda, Mota Vagchhipa, Umarsadi Umargam Fansa-Kalgam, Solsumba, Maroli Navsari Gandevi Amalsad, Bigri, Mendhar Jalalpor Abrama, Dipla, Krushnpur, Matvad Gurukulsupa Amreli S'Kundla Savarkundla Porbandar Kutiyana Devda, Mahiyari Jamnagar Dwarka Okha

Key components for the Nirogi Bal Varsh Care of the mother Unmet need for Family Planning Right of the Girl child to be born Addressing malnutrition Care of the neonates School health Care of special children Clean drinking water and sanitation Jan bhagidari Nirogi gram puruskar

THANKS Let us join hands for a child survival revolution We make a living by what we get; we make a life by what we give! THANKS Dr Amarjit Singh Commissioner, Department of Health & FW Government of Gujarat, Gandhinagar,

Thank You! JOIN HANDS FOR CHILD SURVIVAL REVOLUTION Through Nirogi Bal Varsh Thank You!