Presentation on theme: "The Millennium Development Goals Linkages with Child Health"— Presentation transcript:
1 The Millennium Development Goals Linkages with Child Health The Challenge in IndiaDr. KANUPRIYA CHATURVEDIDr .S.K CHATURVEDI
2 Millennium Development Goals In the United Nations Millennium Summit in 2000, 147 countries adopted MDGsEradicate extreme poverty and hunger by half relative to 1990Achieve universal primary educationPromote gender equality and empower womenEnsure environmental sustainabilityReduce child mortality by two thirds relative to 1990Improve maternal health, including reducing maternal mortality by three quarters relative to 1990Prevent the spread of HIV/ AIDS, malaria and other diseasesDevelop 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 peopleChild mortality: million/yMaternal deaths: million/yAIDS: million/yTB: million/yMalaria million/yIllness, 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.
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.
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.
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.
16 MDG5- Improve maternal health deaths an yearEquivalent to maternal Deaths in a year in IndiaEvery day in the yearEvery six minute in IndiaFor 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/ AIDSSentinel surveillance – optimal way of measuring infection among high and low risk groupsNumber of sentinel sites and their location – an indicator of adequacy of coverage
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 commitmentsRenewed focus on building sustainable health systems and financingSuccessful implementation builds confidence that scaling up of known interventions can accelerate progress on MDGsProcesses 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 policiesChanges in national policies & strategic directions, capacity building, and financial supportStronger health systemsComplementary actions across sectors (education, water, energy, transport)Donor mobilization and harmonizationWe can learn from success stories…
24 Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage Preventive interventions Proportion of all deaths (%)BreastfeedingInsecticide treated materialsComplementary feedingZincClean deliveryWater, sanitation, hygieneNewborn temperature managementTetanus toxoidVitamin AMeasles vaccine
25 Evidence based interventions Estimated U5 Deaths Prevented With Universal Coverage Treatment interventions Proportion of all deaths (%)Oral rehydration therapy 15Antibiotics for sepsis 6Antibiotics for pneumonia 6AntimalarialsZincNewborn resuscitationAntibiotics for dysentery 3Vitamin A <1
26 PoliciesFor scaling up education with investments in schools, teachers and suppliesFor scaling up of health with investments in health staff, doctors, health facilities, medical and paramedical training – for maternal care, IMNCI, supplies of drugs/ equipmentMore decentralized planning and community involvement and public private partnershipGender equality and rights for womenTo 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 counselingDistribution of free ORS, Disposable delivery kits (DDK), contraceptives, Iron- folic acid Vitamin A, anti-malarial & insecticide impregnated bed nets in Malaria endemic areasElimination 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 programImprove governance and policy environmentCommit domestic resourcesImprove 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 logisticsIEC and Program communication to increase access to information, motivating for family/community actions and use of servicesExpansion 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 interventionsMaking universally accessible- the outreach servicesInstitution 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 accurateNational Family Health Survey) NFHS- fairly accurateRCH district rapid household surveys: low precisionCauses of mortality--RGI:Fairly elaborate and reliableDelay in sharing collated informationRecent Involvement of Medical Colleges--QualityDisaggregated data for urban and rural India
32 Data sources MMR Direct methods- large sample size required Indirect methodsSnow ball techniqueHouse- to house survey- betterSisterhood methodEstimating 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/ deathsOver reporting of cure rates to meet the targets
34 Reasons for the shortfall Availability-Adequacy of supply- satisfactoryPeriodicity a bottleneckQuality of equipment/ drugs- need improvementAccessibility-Difficult to reach areas- neglectedGender and socioeconomic discriminationRound the clock services: questionableAccessibility of govt services in urban areas
35 Reasons for the shortfall UtilizationLack of awareness about servicesIrregularity of servicesQuality not always maintainedAdequate coverageDrop outs- a common factorEffective coverageSkills of workers always not up to the desired level
36 Costs and benefitsExisting system takes into account supplies, staff and minimal on infrastructuresFive 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: RecommendationsEnsure effective convergence of all departments, public and private sector & developing partners,..Prioritize the household and community-level interventionsFace real challenge of reaching high levels of effective coverage with evidence-based interventions among under-privileged communityAddress operational bottlenecks & management issuesWork efficiently with community-level private providers.Public Private partnership efforts, involvement of NGOsOther InitiativesPublic Private Partnership—in Immunization, Integrated Management of Childhood illnesses (IMNCI)