Attaining the Millennium Development Goals Prasanna Hota Secretary Department of Family Welfare Interventions to reduce infant and maternal mortality

Goal 4: Infant and Child Mortality 2/3 rd reduction in child mortality between 1990 and 2015 In India this implies reducing IMR to 27 per 1000 live births and Under 5 mortality to 32 per 1000 live births by 2015.

Key Findings Substantial declines in IMR Inter- and intra- state variations in levels and in rates of change Clustering of deaths in a few states Gender disparity in infant mortality Maternal education and female literacy Strong inverse association with immunization coverage Ante-, neo-, and post-natal care improvements will help reduce IMR The MDGs CAN be attained with some commitment

successfully demonstrates and reconfirms what many of us working in this area have intuitively believed to be true; needs a second volume, that focuses on a “product package” that will enable us to move from from what we know and have now cogently demonstrated to the desired outcomes. The report…

What do we need? A Navigation System that tells me how to get to my goals most effectively. We need a road map to tell us how we should get there.

What are the problems? Basic housekeeping is lacking in this sector; Efficiency – converting interventions to outcomes is poor; Data systems are inadequate and needs to be strengthened in numerous dimensions – including coverage and quality; Accountability needs to be incentivized;

How can this be done? Improve social service delivery. This is difficult since: (a) it is more difficult to standardize quality across services than products, as there is people to people interaction; (b) Quality of service can be intangible; (c) Intimate contact between service provider and service user. Some of these concerns could be addressed through technical solutions such as e- services and through improving monitoring and evaluation.

How can this be done? Improve management capability in the medical and health services community In finance management Human resource management Product and process flows

Way Forward Identify a target to focus on – say, IMR; Let us sit with our medical, public health, infrastructure, economic, planning specialists and public officials to develop a proposal to attack IMR in a specified high IMR area in India; We then sit with financial experts, chartered and cost accountants and fully cost this intervention; We set in place the necessary personnel, M&E, and other inputs prior to initiating the IMR intervention; Implement this intervention and study the results.