Health and Education are the prime requirement for development of nation and states. It is unfortunate that even after more than six decades of independence;we are still termed as most backward nation on number of health and education indicators.{facts – i.e. 42% of Indian children are malnourished etc, include IMR rate which is highest in MP.} Now time has come to find the reasons why even after investing huge amount we could not make satisfactory progress in health sector especially of women and children. If these impediments are removed, nation can expects major breakthrough in the sector. The main objective of the Department of Women & Child Development is to reduce Maternal Mortality Rate, Infant Mortality rate and Malnutrition among children and women. Thus main responsibility of implementation of Integrated Child Development Services (ICDS) Programme in the State lies with the department.{include ICDS background and its problems}. schemes/programs include women group formation, legal literacy programme for women, elimination of prostitution, Beti Bachao Abhiyan for increasing female sex ratio, empowering Adolescent Girls of 11 to 18 years by improving their nutritional and health status through Rajiv Gandhi Scheme for Empowerment of Adolescent Girls(SABLA), up gradation of home skills, life skills andvocational skills. The Department also reviews, suggests and makes suitable amendments in various
laws and rules concerned with women’s status for women’s empowerment. Integrated child protection scheme ( ICPS) has been started especially for the children for their integrated welfare and rehabilitation who are in the difficult situation.For improving sex ratio in age group 0-6 years,Beti Bachao Abhiyan (Save the Girl Child Campaign) is being implemented in the State.
Infant Mortality Rate
One of the most sensitive indicators of the health status of a population is Infant Mortality Rate. The IMR in India is steadily decreasing, which is 50 per 1000 live births. It is 34 in urban areas far lower than 55 of the rural area during 2009.Further, it also varies across states with Kerala has the lowest IMR with 12 and the highest is in Madhya Pradesh with IMR of 67. It is observed from the National Family Household Survey-3 and District Level Household Survey -3 that the higher rates of antenatal, institutional deliveries and postnatal are associated with lower IMR.Infant mortality in rural areas is 50% higher than in the urban areas. Children whosemothers have no education are more than twice as likely to die before their first birthdayas children whose mothers have completed at least 10 years of school. In addition,children from scheduled castes and scheduled tribes are at greater risk of dying than otherchildren. The risk is high in case of mother‟s age is less than 20 or above 30.It is also important to note that IMR constitutes significant portion of Neo-natal Mortality. Neo-natal Mortality in India varies between 60 to 75% in various states.The causes of IMR in India comprise of Acute Respiratory Infections, Diarrhea, Sepsis, Asphyxia, Prematurity and others.In spite of much effort only 46.6 % deliveries are assisted by Trained Health Care Personnel of which 38.7% are Institutional deliveries. This indicates that concerted efforts will be required under Home Based Newborn Care(HBNC) to reduce the IMR and Neo-natal Mortality Rate (NMR) further.Also inverse relationship is observed with higher education status of mothers and higher standard of living index.
Maternal and Child Health Programmes in India
India has a long history of Maternal and Child Health Programmes since independence, which have undergone significant shifts in their emphasis over time. The 5-year phase of RCH II was launched in 2005 with a vision to bring about outcomes as envisioned in the MDGs, the National Population Policy 2000, the National Health Policy 2002 and The Tenth Five Year Plan, minimizing the regional variations in the areas of RCH and population stabilization through an integrated, focused, participatory programmes meeting the provisions of assured, equitable, responsive quality services. The implementation of the RCH II was strengthened with its integration into the NRHM, where improved programme implementation and health system development was seen as mutually reinforcing processes. In the five years since the launch of the NRHM in 2005, institutional deliveries have increased rapidly witnessing a remarkable ump in coverage from 7.39 to 90.37 lakh beneficiaries in 2008-09. Also quality of antenatal and postnatal care is also being strengthened, while the ASHA providing support for increasing utilization.
Major initiatives in Child Health under RCH II:
The strategy for child health care aim to reduce under 5 child mortality through interventions at every level of service delivery and through improved child care practices and child nutrition. One major component of the strategy was training to the AWWs and ANMs for early diagnosis and referral to facilities. At the facility level, the focus was on strengthening capacity to cope with essential newborn care in newborn corners in every facility and promptly treat or refer sick newborns and sick children to more specialized newborn stabilization units or special newborn care units at the district hospital. 213 sick newborn care units have been set up so far.IMNCI strategy encompasses a range of interventions to prevent and manage 5 major childhood illnesses – ARI, Diarrhea, Measles, Malaria and Malnutrition with the major causes of neonatal mortality – prematurity and sepsis. In addition, IMNCI teaches about nutrition including breast feeding promotion, complimentary feeding and micronutrients.It focuses on preventive, promotive, a curative service i.e. it gives a holistic outlook to the programme. Major components of the strategy are:(a) Strengthening the skills of the health care workers(b) Strengthening the health care infrastructure(c) Involvement of the communityThe first two components are facility based IMNCI and the third one is community based IMNCI.
The major features of the IMNCI are:
- Focus on the newborn care and young infant- since a significant proportion of child mortality is centered in the first few months of life
- Development of protocol and algorithm for home visits by field functionaries like ANMs and AWWs for all newborns in the first week of life.
- Ensuring harmonization between existing health interventions and programmes like ICDS and anti Malaria programmes implemented by agencies other than the Department of Family Welfare that impact child health.
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