1. The Millennium Development Goals Linkages with Child Health
The Challenge in India
Dr. KANUPRIYA CHATURVEDI
Dr .S.K CHATURVEDI

2. Millennium Development Goals
In the United Nations Millennium Summit in 2000, 147 countries adopted MDGs
Eradicate extreme poverty and hunger by half relative to 1990
Achieve universal primary education
Promote gender equality and empower women
Ensure environmental sustainability
Reduce child mortality by two thirds relative to 1990
Improve maternal health, including reducing maternal mortality by three quarters relative to 1990
Prevent the spread of HIV/ AIDS, malaria and other diseases
Develop a global partnership for development

3. The Global Challenge Nearly half the MDGs relate to health & nutrition
The targets cover a large share of the burden of disease & deaths among poor people
Child mortality: million/y
Maternal deaths: million/y
AIDS: million/y
TB: million/y
Malaria million/y
Illness, death, malnutrition impede economic growth & contribute to income poverty

4. Goal 4: reduce child mortality
Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.
Close to 11 million children die every year before reaching the age of five, or 20 per minute,30,000 per day. Nearly 4 million of these die in the first 28 days of life.
Most of the deaths are due to a handful of causes (pneumonia, diarrhoea, measles, malaria, and neonatal causes).
Malnutrition is associated with 54% of the deaths.
99% of the deaths are in low and middle-income countries, mostly in sub-Saharan Africa and South Asia.
Measles deaths world-wide dropped by nearly 40% between 1999 and 2003, with the largest reduction in Africa.

6. Countries with most under-5 deaths, 2000

7. Goal 5: Improve maternal health
Every year, at least 529,000 women die in pregnancy or childbirth. 99% of these occur in the developing world.
For every woman who dies in childbirth, around 20 more suffer injury, infection or disease - touching approximately 10 million women each year.
Complications resulting from unsafe abortions account for 13% of all maternal deaths.

8. Avoidable maternal deaths each year

9. Goal 6: Combat HIV/AIDS, malaria and other diseases
Every day, 8000 people die of AIDS-related conditions or some 3 million deaths per year. Only of the five to six million people in the advanced stage of the disease had access to the anti-retroviral therapy in developing countries at the end of 2003.
There are 8.8 million new cases of tuberculosis (TB) a year. There are 5500 deaths a day, or million deaths worldwide each year from TB. Some 80% of this morbidity and mortality from TB falls on 22 high-burden countries.
There are almost 300 million cases of acute cases of malaria each year. More than a million cases of malaria are fatal each year. Some 90% of the burden falls on tropical Africa, where malaria is a major cause of mortality and morbidity in children under five years of age.

10. Challenges in India

11. MDG4- Reduce child mortality
Infant and Young Child mortality remains unacceptably high.
About 2.4 million deaths occur annually in under-5 year-old children in India. Seven out of every 10 of these are due to diarrhea, pneumonia, measles, or malnutrition and often a combination of these conditions.
In India abut 30% of children born with LBW.

12. Goal 4. Reduce child mortality: Infant Mortality Rate

16. MDG5- Improve maternal health
deaths an year
Equivalent to maternal Deaths in a year in India
Every day in the year
Every six minute in India
For every Maternal Death 20 mothers start leading a life in the morbid conditions.
Every here lakh children get MDS (Maternal Deprivation Syndrome)

17. Direct causes of Maternal Deaths
Haemorrhage (Antepartum & Postpartum).
Pregnancy Induced Hypertension & Eclampsia.
Sepsis & Septicaemia.
Obstructed Labour & Ruptured Uterus.
Septic Abortion.
Other Causes.

18. MDG6- Combat HIV/AIDS, malaria and other diseases
Halt and begin to reverse the spread of HIV/ AIDS
Sentinel surveillance – optimal way of measuring infection among high and low risk groups
Number of sentinel sites and their location – an indicator of adequacy of coverage

20. People living with HIV

21. Combat malaria and other diseases
Target: Halt by 2015 and begin reversal of incidence of malaria and other major diseases

22. Why a special effort now?
New political and financial commitments
Renewed focus on building sustainable health systems and financing
Successful implementation builds confidence that scaling up of known interventions can accelerate progress on MDGs
Processes and mechanisms emerging to improve donor harmonization and aid effectiveness

23. But rapid gains are possible through…
Practical approaches to achieve the MDGs- key interventions and policies
Changes in national policies & strategic directions, capacity building, and financial support
Stronger health systems
Complementary actions across sectors (education, water, energy, transport)
Donor mobilization and harmonization
We can learn from success stories…

24. Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage
Preventive interventions Proportion of all deaths (%)
Breastfeeding
Insecticide treated materials
Complementary feeding
Zinc
Clean delivery
Water, sanitation, hygiene
Newborn temperature management
Tetanus toxoid
Vitamin A
Measles vaccine

25. Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage
Treatment interventions Proportion of all deaths (%)
Oral rehydration therapy 15
Antibiotics for sepsis 6
Antibiotics for pneumonia 6
Antimalarials
Zinc
Newborn resuscitation
Antibiotics for dysentery 3
Vitamin A <1

26. Policies
For scaling up education with investments in schools, teachers and supplies
For scaling up of health with investments in health staff, doctors, health facilities, medical and paramedical training – for maternal care, IMNCI, supplies of drugs/ equipment
More decentralized planning and community involvement and public private partnership
Gender equality and rights for women
To pursue huge quick wins for health goals

27. Examples of rapid gains in Health sector
Training of large number of village workers to ensure basic expertise, services and counseling
Distribution of free ORS, Disposable delivery kits (DDK), contraceptives, Iron- folic acid Vitamin A, anti-malarial & insecticide impregnated bed nets in Malaria endemic areas
Elimination of user fees for basic health services financed by increased domestic and Donor resources.

28. What does this mean for India
Develop credible strategies and plans to reach MDGs as part of PRSP and public expenditure program
Improve governance and policy environment
Commit domestic resources
Improve monitoring and evaluation of results

29. Examples of rapid gains in Health sector
Expanding access to RCH services by focusing on out reach services, making health facilities functional and ensuring supplies and logistics
IEC and Program communication to increase access to information, motivating for family/community actions and use of services
Expansion of use of proven effective drug combinations for AIDS, TB, Malaria, Diarrhea and ARI( pneumonia and Asthama)

30. Approach: Service delivery mode based planning of interventions
Scaling interventions with high efficacy- family and community based interventions
Making universally accessible- the outreach services
Institution based and individual child centered services like malnutrition management facilities

31. Data sources IMR and Child mortality Causes of mortality--RGI:
Sample registration system (SRS): at national and state level- fairly accurate
National Family Health Survey) NFHS- fairly accurate
RCH district rapid household surveys: low precision
Causes of mortality--RGI:
Fairly elaborate and reliable
Delay in sharing collated information
Recent Involvement of Medical Colleges--Quality
Disaggregated data for urban and rural India

32. Data sources MMR Direct methods- large sample size required
Indirect methods
Snow ball technique
House- to house survey- better
Sisterhood method
Estimating from sex differentials in mortality at reproductive ages involving regression techniques

33. Data sources HIV/ AIDS/ Malaria/ TB Reports from program implementers
Under reporting of incidence/ prevalence/ deaths
Over reporting of cure rates to meet the targets

34. Reasons for the shortfall
Availability-
Adequacy of supply- satisfactory
Periodicity a bottleneck
Quality of equipment/ drugs- need improvement
Accessibility-
Difficult to reach areas- neglected
Gender and socioeconomic discrimination
Round the clock services: questionable
Accessibility of govt services in urban areas

35. Reasons for the shortfall
Utilization
Lack of awareness about services
Irregularity of services
Quality not always maintained
Adequate coverage
Drop outs- a common factor
Effective coverage
Skills of workers always not up to the desired level

36. Costs and benefits
Existing system takes into account supplies, staff and minimal on infrastructures
Five country assessments and estimates indicate that annual public investments or MDGs will be 80US$ per person in scaling up to 124 US$ in 2015

37. Creation of national / state / district level processes for scaling up
Child Survival Partnership: Recommendations
Ensure effective convergence of all departments, public and private sector & developing partners,..
Prioritize the household and community-level interventions
Face real challenge of reaching high levels of effective coverage with evidence-based interventions among under-privileged community
Address operational bottlenecks & management issues
Work efficiently with community-level private providers.
Public Private partnership efforts, involvement of NGOs
Other Initiatives
Public Private Partnership—in Immunization, Integrated Management of Childhood illnesses (IMNCI)