Posted 08 Dec 2016 12:53 PM


Child Health
The Reproductive and Child Health programme (RCH) II under the National Rural Health Mission (NRHM) comprehensively integrates interventions that improve child health and addresses factors contributing to Infant and under-five mortality. Reduction of infant and child mortality has been an important tenet of the health policy of the Government of India and it has tried to address the issue right from the early stages of planned development. The National Population Policy (NPP) 2000, the National Health Policy 2002 and the Eleventh Five Year Plan (2007-12) and National Rural Health Mission (NRHM - 2005 – 2012) have laid down the goals for child health. Further, Twelfth Five Year plan (2012-2017) and National Health Mission (NHM) laid down the Goal to Reduce Infant Mortality Rate (IMR) to 25 per 1000 live births by 2017.
Child Health Indicator Current status RCH II/NHM 2010/2012 MDG 2015 NHM (By 2017)
IMR (Infant Mortality Rate) 40 (SRS 2013) <30 <28 25
Neonatal Mortality rate 28 (SRS 2013) -- -- --
Under 5Mortality Rate 49 ( SRS 2013) -- <42 --
Source: Sample Registration System (SRS) 2013
Thrust areas under Child Health Programme
1. Neonatal Health
Essential new born care (at every ‘delivery’ point at time of birth)
Facility based sick newborn care (at FRUs & District Hospitals)
Home Based Newborn Care
2. Nutrition
Promotion of optimal Infant and Young Child Feeding Practices
Micronutrient supplementation (Vitamin A, Iron Folic Acid)
Management of children with severe acute malnutrition
3. Management of Common Child hood illnesses
Management of Childhood Diarrhoeal Diseases & Acute Respiratory Infections Immunization
Intensification of Routine Immunisation
Eliminating Measles and Japanese Encephalitis related deaths
Polio Eradication
The strategies for child health intervention focus on improving skills of the health care workers, strengthening the health care infrastructure and involvement of the community through behaviour change communication.

Facility Based Newborn and Child Care (FBNC)
Neonatal mortality is one of the major contributors (2/3) to the Infant Mortality. To address the issues of higher neonatal and early neonatal mortality, facility based newborn care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust area under NHM.

Special Newborn Care Units (SNCU) :
States have been asked to set up at least one SNCU in each district. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services.
Newborn Stabilization units (NBSUs):
NBSUs are established at community health centres /FRUs. These are 4 bedded units with trained doctors and nurses for stabilization of sick newborns.
New Born Care Corners (NBCCs):

These are 1 bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.
A comprehensive “Facility Based Newborn Care Operational Guide- 2011, a guideline for planning and Implementation” have been published and disseminated in 2011 by Child Health Division, MoHFW, GOI to act as reference tool for the states to take necessary steps in implementation of same.

About 56,000 women in India die every year due to pregnancy related complications. Similarly, every year more than 13 lacs infants die within 1year of the birth and out of these approximately 9 lacs i.e. 2/3rd of the infant deaths take place within the first four weeks of life. Out of these, approximately 7 lacs i.e. 75% of the deaths take place within a week of the birth and a majority of these occur in the first two days after birth.
In order to reduce the maternal and infant mortality, Reproductive and Child Health Programme under the National l Health Mission (NHM) is being implemented to promote institutional deliveries so that skilled attendance at birth is available and women and new born can be saved from pregnancy related deaths.
Several initiatives have been launched by the Ministry of health and Family Welfare (MoHFW) including Janani Suraksha Yojana (JSY) a key intervention that has resulted in phenomenal growth in institutional deliveries. More than one crore women are benefitting from the scheme annually and the outlay for JSY has exceeded 1600 crores per year.

IMNCI (Integrated Management of Neonatal & Childhood Illnesses ):
Includes Pre-service and In-service training of providers, improving health systems (e.g. facility up-gradation, availability of logistics, referral systems), Community and Family level care.
F-IMNCI (Facility Based Integrated Management of Neonatal and Childhood Illness):
F-IMNCI is the integration of the Facility based Care package with the IMNCI package, to empower the Health personnel with the skills to manage new born and childhood illness at the community level as well as at the facility. Facility based IMNCI focuses on providing appropriate skills for inpatient management of major causes of Neonatal and Childhood mortality such as asphyxia, sepsis, low birth weight and pneumonia, diarrhea, malaria, meningitis, severe malnutrition in children. This training is being imparted to Medical officers, Staff nurses and ANMs at CHC/FRUs and 24x7 PHCs where deliveries are taking place. The training is for 11 days.

Home Based New Born Care (HBNC)
A new scheme has been launched to incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration, amounting to a total of Rs. 250 for five visits. This would be paid at one time after 45 days of delivery, subject to the following:
Recording of weight of the newborn in MCP card
Ensuring BCG , 1st dose of OPV and DPT vaccination
Both the mother and the newborn are safe till 42 days of the delivery, and
Registration of birth has been done
A comprehensive “Home Based Newborn Care Operational Guideline- 2011” has been developed, published and disseminated in 2011 by Child Health Division, MoHFW, GOI to provide framework and guidance to enable a coherent home based new born care strategy and act a reference tool for the states to plan necessary interventions.


NSSK (Navjat Shishu Suraksha Karyakram):
NSSK is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have a trained health personal in Basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country.
IYCF (Infant and Young Child Feeding):
Infant and Young Child Feeding is the single most preventive intervention for child survival. It advocates the following:
Early initiation (within one hour of birth) and exclusive breast feeding till 6 months
Timely complementary feeding after 6 months with continued breast feeding till the age of 2 yrs
Comparison of indicators of child feeding practices:
Indicator CES (2009) DLHS-3 (2007-08) NFHS-3 (2005-06)
Children under three years breastfed within an hour of birth 33.5% 40.2% 24.5%
Children 0-5 months exclusively breastfed 56.8% 46.4% 46.3%
Children age 6-35 months breastfed for at least 6 months -- 24.9% --

Nutritional Rehabilitation Centres (NRC)

(Treat severe acute malnutrition amongst children):
Severe Acute Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhoea and pneumonia. Deaths amongst SAM children are preventable, provided timely and appropriate actions are taken.
• Nutritional Rehabilitation Centres (NRCs) are being set up in the health facilities for inpatient management of severely malnourished children, with counselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow up.
An “Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition-2011” has been published and disseminated in 2011 by Child Health Division, MoHFW

Child Morbidity & Mortality Reduction
Reduction in morbidity and mortality due to Acute Respiratory Infections (ARI) and Diarrhoeal Diseases:
Promotion of zinc and ORS supplies is ensured.

Childhood Diarrhoea :
In order to control Diarrhoeal diseases Government of India has adopted the WHO guidelines on Diarrhoea management.
India introduced the low osmolarity Oral Rehydration Solution (ORS), as recommended by WHO for the management of diarrhea
Zinc has been approved as an adjunct to ORS for the management of diarrhea. Addition of Zinc would result in reduction of the number and severity of episodes and the duration of diarrhea
New guidelines on management of diarrhoea have been modified based on the latest available scientific evidence

Acute Respiratory Infections :
Acute Respiratory Infections forms 19 % of all under five mortalities in India (WHO 2007 report) and along with Diarrhoea are two major killers of under five children
India leads the world in the number of pneumonia cases with nearly 44, 00, 000 cases yearly. Early diagnosis and appropriate case management by rational use of antibiotics remains one of the most effective interventions to prevent deaths due to pneumonia. The ARI guidelines are being revised with the inclusion of the latest available global evidence

Nutrient Supplementation
Supplementation with micronutrients through supplies of Vitamin A & iron supplements
Vitamin – A:
• The policy has been revised with the objective of decreasing the prevalence of Vitamin A deficiency to levels below 0.5%, the strategy being implemented is:
1,00,000 IU dose of Vitamin A is being given at nine months
Vitamin A dose of 2,00,000 IU (after 9 months) at six monthly intervals up to five years of age
All cases of severe malnutrition to be given one additional dose of Vitamin A
Coverage with Vitamin A CES (2009) DLHS-3 (2007-08) NFHS-3 (2005-06)
Children 9 months and above who have received at least one dose of Vitamin A 65.4 % 55.0% 24.8%

Iron and Folic Acid supplementation:
To manage the widespread prevalence of anaemia in the country, the policy has been revised.
Infants from the age of 6 months onwards up to the age of five years shall receive iron supplements in liquid formulation in doses of 20mg elemental iron and 100mcg folic acid per day per child for 100 days in a year.
Children 6-10 years of age shall receive iron in the dosage of 30 mg elemental iron and 250mcg folic acid for 100 days in a year.
Children above this age group would receive iron supplements in the adult dose

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