1. " Continuum of care-Extending horizons" Dr. Vikas K. Desai Gujarat

2. State’s Target and Achievements 2H & FW Deptt. Health & Family Welfare Department

3. Trends of Institutional Deliveries Source: HMIS Health & Family Welfare Department

4. Trend of Infant Mortality Rate (IMR) in Gujarat Source: SRS Infant Mortality Estimates

5. Trend of CBR & TFR (SRS) Trend of CBRTrend of TFR Gujarat

6. Child Sex Ratio (0-6 Years): India and Gujarat (Census) H & FW Deptt.6

7. SRS (2012) GujaratMaha rashtra Tamil Nadu Kerala Birth rate21.116.615.714.9 Death rate6.66.37.46.9 IMR38252112 MMR (SRS ‘07-’09) 1481049781

8. Trend of BR (SRS) 15 21

9. Trend of IMR Target by 2015 is 28/1000LB Gujarat Decline of 6 in 3 yrs.= Decline of 2 /yr. (3.4/yr to reach to 28by ‘15) Not in the list of states In closer proximity to achieving the MDG target.

10. Malnutrition in <36months children (NFHS 3 ‘05-’06) In Gujarat Compared to Kerala Underweight children are more by 18% Wasting (Acute malnutrition) is almost same Stunting (Chronic Malnutrition) is more by 21% Gujarat needs special and high focus on Adolescent and Pregnant mothers Nutrition also

11. CONTINUUM OF CARE (Lifecycle Problem and Approach) Women Reproductive age ANC BF New born <36m3-6yrs. School age Adolesc ent girls

12. CONTINUUM OF CARE (Quantity- Quality) Doable / Simple to More technical Immunisation- Polio, Measles Institutional delivery - safe home delivery Neonatal health focus in Infant health Diarrhoea and Pneumonia management SAM management (Bakshaktim kendra) Service delivery - IPC ENBC-IMNCI-FIMNCI

13. CONTINUUM OF CARE (Linking care)

14. CONTINUUM OF CARE (level of care -Home based to Tertiary care) MAMTA Divas MAMTA Sandarbh MAMTA Mulakat

15. 1. ASESS 2.CLASSIFY 3.MANAGE IMNCI APPROACH 4. FOLLOW UP

16. “Healthy Child” Physically, Mentally, Socially and Spiritually ‘Womb to Adolescence” Lifecycle approach to Care “ Universal Coverage” No child is left out due to poverty, geography, gender, Out of school, Challenged “ Evidence to Action” Implementation of evidence based interventions Nirogi Bal Varsh 2008 Concept

17. CONTINUUM OF CARE (Service Record Tracking ) Pregnancy (H+W) Newborn (H+W) Preschool (H+W) School (H+E) Adolescent (H+W+E) Young adult (H+E) Unique ID & Common minimum E program Data records To provide Continuum Individual record

18. CONTINUUM OF CARE (Tribal-Rural-Urban poor-Urban) Urban OverallPoor Institutional delivery75%53% Full immunisation56%31% Underweight children39%56%

19. CONTINUUM OF CARE (Vulnerable- Poor-All) Overall poor Vulnerable ?

20. CONTINUUM OF CARE (Health-Nutrition-sensory stimulation-Sanitation ) vaccination Nutrition Hygiene/ Sanitation Child care/ stimulation

21. Continuum of care (Intervention/strategy implementation) Adopt Plan Logistics Implem entation Monitor ing Training

22. CONTINUUM OF CARE (Macro-Micro-Trace nutrients) Maternal Nutrition – Birth weight Birth weight Protein Energy Iron Folic acid Vit.AIodine Calcium + Vit.D

23. CONTINUUM OF CARE (Extension of strategy from child-mother)

24. CONTINUUM OF CARE (Supplement to behaviour change)

25. CONTINUUM OF CARE (Public to Private system) Total Institutional delivery/ Sick child care Private maternity homes/ Pediatric hospitals Adoption of Common evidence based protocols Mother & Child friendly hospitals

26. Thank you THANK YOU Sanitation Health EducationWCD