Position Paper on Child Survival 1. INTRODUCTION Save the Children is a child focused organisation that delivers immediate and lasting improvements in children’s lives. The organisation is committed to improve the health status of children in India and protect them from exploitation, abuse and ill health. In the current context, Save the Children’s primary focus is on supporting the system in accelerating the progress towards Millennium Development Goal 4 aimed at one-third reduction in child mortality rates from 1990 level, by 2015 writing dissertation service uk .
Child Survival Situation in India India is faced with an unparalleled child survival and health challenge. The country contributes 1. 95 million of the global burden of 9. 2 million under-five child deaths, which is the highest for any nation in the world. Nearly 26 million infants are born each year, of whom nearly 1 million die before completing the first 4 weeks of life and 1. 7 million die before reaching the first birthday. India has a population of 1. 17 billion. Children below the age of 18 years account for 38. 4% of India’s population and of these 127 million are between 0-5 years. The infant mortality rate in India is 54 per 1000 live births and the neonatal mortality is 39/1000 live births. Almost one in every three babies in the world, who die before they are four weeks old, is from India. Less than half (44%) of children of 12-23 months are fully immunized against the six major preventable diseases. 45. 9% of Indian children under three are underweight. Nearly 80% of infants now have anaemia.
Each year 27 million pregnancies take place in the country with only 32. 9% women accessing the Government health services for antenatal care. Only 52% pregnant women have at least three visits for antenatal care. Government of India launched the National Rural Health Mission on 12th April 2005, to provide accessible, affordable and accountable quality health services to the poor households in rural areas. From narrowly defined vertical schemes, the NRHM has shifted the focus to a functional integrated health system at all levels, from the village to the district.
Under the NRHM, the difficult areas with unsatisfactory health indicators have been classified as special focus States to ensure greatest attention where needed. The thrust of the Mission is on establishing a fully functional, community owned, decentralised health delivery system with inter-sectoral convergence at all levels, to ensure simultaneous action on a wide range of determinants of health like water, sanitation, nutrition, social and gender equality in addition to health per se.
In order to ensure delivery of quality services to the people, Indian Public Health Standards (IPHS) have been set for all Government health facilities such as the Sub Centre, Primary Health Centre and Community Health Centre for the type and number of medical and paramedical personnel in them and the basic infrastructure.
The Government expects that evidence based interventions like the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) for improved child survival and that the Janani Suraksha Yojana (JSY) which promotes institutional deliveries will lead to India attaining the health related Millennium Development Goals (MDGs). The initiatives like reform of the Integrated Child Development Services Scheme (ICDS), and its universalisation with quality are given emphasis to bring rapid improvement in the children’s health and nutrition status, which however will depend upon the effective implementation of these schemes.
There is an urgent need to enhance the capacities of the grassroots level functionaries so that, using the existing framework of NRHM and ICDS, they can deliver quality services to improve the scenario of maternal and child health in India. Another area which is needed to be strengthened is the on-ground coordination amongst the key departments who can have an impact on the current women and child health situation. Malnutrition: National Family Health Survey (NHFS-3) showed that there has not been much improvement in the nutritional status of children, within the last eight ears. During NFHS-2 (1998-1999), 47% of children under three were found to be underweight while 46% of children under three years of age being underweight, according to. This means every second child under six years of age in India is underweight, a statistic worse than that in sub-Saharan Africa. Almost half (48. 4%) of all children under five are stunted (short for their age, an indicator of chronic malnutrition) while 20% of children are wasted (too thin for their height, an indicator of acute malnutrition).
As much as 43% children are underweight for their age. Exclusive breastfeeding and appropriate complementary feeding of children which are identified as major determinants of child survival still remain significant challenges to be addressed. Only 69% of children less than two months of age are exclusively breastfed which drops to 51 percent at 2-3 months and 28 percent at 4-5 months of age. Overall, slightly less than half of the children under six months of age are exclusively breastfed.  Only 53% children receive complementary foods between 6-8 months of age.
Due to cultural beliefs and ingrained practices over ages, many mothers are still not able to follow appropriate infant feeding practices leading to increase in morbidity and mortality of children less than 5 years of age. Over half of all women (56%) in India are anaemic as are 70% of children under the age of five. 22% of all children whose birth weight record is available are low birth weight babies, which is a significant contributing factor to malnutrition later in life. The issue of underweight children is particularly serious in rural areas and among the poorest families, ethnic minorities and lower castes. . KEY ISSUES With one child dying every three seconds, India registers the highest number of child deaths across the globe. The major killers of children are – acute respiratory infections, dehydration due to diarrhoea, measles and neonatal tetanus and in some areas malaria. The high prevalence of malnutrition contributes to over 50% of child deaths. In India, a significant proportion of child deaths (over 40% of under-five Mortality and 64% of infant mortality) take place in the neonatal period. Apart from infections, other causes like asphyxia, hypothermia and pre-maturity are responsible for neonatal mortality.
About one-third of the newborns have a birth weight less than 2500 gram (low-birth weight). A significant proportion of mortality occurs in low-birth weight babies. It has been recognised that further reduction of IMR will require focused attention on Neonatal mortality. The most challenging part of infant mortality, we all know, is the large proportion of newborn deaths, contributing to around 70% of all infant deaths, that too mostly taking place in the first week of life. Mortality rate in the second month of life is also higher than at later ages.
In short, to achieve this goal, India needs extra emphasis to save newborns. Over 50% of the child deaths are associated with malnutrition. Of the 19 million infants in the developing world who have low birth weight (less than 2,500 grams), 8. 3 million are in India. Malnutrition is the result of a combination of factors. They include cultural inhibitions causing low adoption of exclusive breast feeding, poor understanding of complementary feeding; insufficient awareness of nutritional needs lack of purchasing power leading to inadequate access to food, inequitable distribution of available food and poor food habits.
The other key indirect causes include lack of health care services, non availability of clean water and safe sanitation, poverty and lack of livelihood opportunities. 3. OVERALL STATEMENT OF SAVE THE CHILDREN INDIA Save the Children India works to support the communities and families in undertaking actions at their level which can save newborn and young children’s lives. We focus on strengthening community systems by enhancing the capacities of CBOs, involving people and children in their own health care and increasing the awareness of communities to generate demand for quality health services.
For improving the quality and coverage of basic Maternal, Newborn, Child health and nutrition services, Save the Children India also works on capacity building of Anganwadi workers, Accredited Social Health Activists (ASHA) and Auxiliary Nurse Midwives (ANM) in its areas of operation. This contributes directly towards strengthening the supply side of services. Save the Children India will work as a catalyst to initiate social change around child survival and strengthen coordination, as recommended in the National Rural Health Mission, amongst various sectors/programmes/departments which work for addressing child survival related issues.
Save the Children India for addressing the child survival issues through improved service delivery, supports and works in close coordination with the departments of health and women and child development. The organisation, specifically works through the framework of Integrated Child Development Services Scheme (ICDS) to deliver benefits to the children. Save the Children India’s principal strategy is to develop innovative solutions to the problems which the system encounters in delivering quality maternal, newborn child health and nutrition services.
Another area which Save the Children India would also address is access to safe drinking water and basic sanitation, as this is an indispensable component of health and development. Studies show that the coverage of safe drinking water is low and much slow progress has been made globally in improving sanitation coverage. Incorporating principles of sustainable development into policies and strategies would cause some improvements towards health goals. 4. SAVE THE CHILDREN’S STRATEGIES WILL BE: To address maternal, neonatal, child health and nutritional needs of the communities, by involving the community itself and the children in the process • Enhance the capacity of service providers to deliver quality Maternal child health and nutrition services • Generate demand for basic health care services in the communities, with special focus on marginalised and underprivileged sections, through awareness generation activities • Strengthen convergence between key departments to ensure effective delivery f quality health services • Push the agenda of child survival to highest priority through advocacy at all levels • Generate demand for the quality child survival services by creating awareness through public campaigns for the communities Save the Children India’s Plan of Action: In the initial phase, health and nutrition interventions will be undertaken in the states of Rajasthan, West Bengal, Andhra Pradesh, Bihar, Orissa, Gujarat and Maharashtra. These are the states where Save the children has been working for several years in the field of education, child protection and disaster relief.
With deep understanding of the issues at all levels, as stated above, Save the Children India realises that in these states there is an urgent need to address health and nutrition issues to make the approach more holistic. In designing the health and nutrition interventions Save the Children in India will keep the issues of child protection and child rights in focus. Save the Children India, will try to involve children in the advocacy work at the grassroots level.
We plan to replicate the good practices which have been tested and proved to be effective in addressing the issues of child survival. In all its interventions, Save the Children India will address the weaker areas of the system as revealed by the in national and state level demographic and health studies. For all the activities, Save the Children India works in close coordination with the Government structure and other civil society players in the field. Key Target Groups: Children are the central point for planning, in all our interventions.
We target to deliver benefits to newborns, children under the age of five years, pregnant and nursing mothers through our interventions. The organisation strives to provide quality community based health and nutrition services through capacity building of community based volunteers, health and ICDS functionaries, and awareness generation in the communities about child health and nutrition issues along with Child Rights and protection issues. Save the Children India expects the benefits of these approaches to cover over 500,000 children in the next 3 years.
Programmatic Approach: In order to provide support to the public health delivery system, Save the Children India adopts locally and culturally relevant support models to deliver community based child health and nutrition services. The geographic focus for implementing programmes will be on the underperforming districts with large percentage of most marginalised and vulnerable population. The programme models are implemented through communities, and community based organisations / NGOs and the grassroots level workers of the public health delivery system.
Save the Children India provides technical, programmatic and financial support to all the implementing partners. Save the Children India also works to support the existing frameworks of health and ICDS, and strengthens them rather than creating a parallel structure. This approach of strengthening community systems is a sustainable support to the health care delivery system. Save the Children India will work with the Government at all levels and play a major role in advocating for evidence based changes in policies that affect children. In all the activities we involve communities, with special emphasis on involving children. . FUTURE DIRECTIONS In July 2008, Save the Children India initiated a health and nutrition project in the states of Rajasthan and West Bengal, working with communities and health workers to improve health and nutrition of mothers and children in the region. In September 2008, Emergency Health and Nutrition interventions were rolled out in the states of Bihar and Orissa as a response to the floods. Save the Children India’s future work to address the issues of child Survival will be focused on the underperforming districts of Rajasthan, Orissa, West Bengal, Bihar and Delhi.
In the subsequent phase expansion to other states is being planned. The programme designs will be based on the area specific priorities through contextualisation and up-scaling the high impact good practices as evidenced in the current activities. ———————–  UNICEF, State of the World’s Children ( SoWC)2009  UNICEF – SoWC 2009  UNICEF – SoWC 2009, NFHS3 2005-06 & SRS Bulletin October 2008  WHO Health Statistics 2007  NFHS-3 2005-06  UNICEF SoWC 2008  NFHS-3 2005-06 p. 196  NFHS 3 2005-06  NFHS-3 2005-06  NFHS-3 2005-06  UNICEF SoWC 2008  WHO India Web page  UNICEF SoWC 2008