Accelerating Child Survival and Development in Gujarat and in India Dr Genevieve Begkoyian, MD MPH Chief of Health, India Country Office Healthy Gujarat – Agenda for Action Mahatma Mandir, Gandhinagar, Gujarat 3 December, 2013

India today No case of polio in 33 months 60 million new toilet users 11.1 million more children in school Food security bill passed Nutrition missions formed NMR declined by 9% in 2 years And ….  Stunting decreased by 16% in Maharashtra since 2006  U5MR reduction from 118 to 55 between 1990 and 2011  IMR in Gujarat 10 points decline in last 3 years

Maternal Mortality in Gujarat Source: SRS Goal Current Interventions SBA, BEmOC, CEmOC VHND/ Mamta Diwas Referral transport through EMRI 108 Chiranjeevi Yojana Janani Suraksha Yojana Janani Shishu Suraksha Karyakram Focus on Adolescent Health

Total 38 Rural 45 Urban 24 Source: Latest SRS reference by RGI Goal 29  > 50,000 deaths among under-ones annually  70 % infant deaths during neonatal period  > 50,000 deaths among under-ones annually  70 % infant deaths during neonatal period Infant Mortality trends in Gujarat

Causes of Under 5 Deaths : India Data Source : CHERG Estimates for Causes of Under 5 Deaths 2012, based on 2010 Avoid preventable deaths

Success factor 1 Leadership at the highest level to ensure priority to child health and development outcomes across sectors, with large investments

Data not available Below 5 % 5 % - 10 % >10 % - 25% >25 % >7 millions children not imunized in India 69% of partially and un-immunized children in 6 states: Uttar Pradesh Bihar Madhya Pradesh, Rajasthan West Bengal Gujarat Source: CES 2009; Full immunization of children surveyed months

~ 256,000 Migrant sites Migrant sites High risk areas in settled population ~ 166,000 HR areas in settled population = 10 Migrant sites = 10 HR sites Identification of High Risk Areas, India, February 2013

Full Immunization (%)-State wise coverage Source: CES (2009) Reaching the 7 millions children un immunized All India immunized children

Success factor 2 RESULTS BASED focusing on most deprived Reduction in neonatal mortality

Focusing together on those at highest risk: the Adolescent Adolescent – Out of school – Early marriage – Early pregnant – Anemia, Malnutrition High risk Mother & child – Prematurity – Low birth weight – Post partum Hemorrhage Focus of QUALITY care including nutrition and hygiene practices Zero tolerance to maternal and newborn death Inter departments and cross line ministries coordination

Success factor 3 Evidence based: facility based, outreach community based strategies

Continuum of Care SNCU Newborn Stabilization Units Newborn Stabilization Units District Level IMNCI / HNBC / NBCC Community/PHC level CHCs at block level Continuum of care for new born survival

Success factor 4 Equity focused and targeted interventions maternal and newborn for most vulnerable Scale up interventions, as part of continuum of care (RMNCH+A)

Partnerships with Private sector Treatment seeking behavior in childhood diarrhea (CES-2009) Focused areas Partnership Professional bodies Accreditation Improving quality of care

5 Cleans Clean hands Clean surface Clean blade Clean cord Clean thread PLUS Functioning toilet and HWWS facilities Hand Soap Surface cleaning agents Clean water supply Laundry facility Disposal bin Safe delivery & new born care Facility to ensure Availability of functional toilet and HWWS facilities Availability of HW soap Surface cleaning agents Availability of clean water supply Laundry facilities Availability of disposal bin Hygiene protocols for RMNCH +A Behavior change for healthy life sustainable practices

…but the change is possible The change is happening…

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