Save the Children

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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.

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[1]. India has a population of 1.17 billion. Children below the age of 18 years account for 38.24% of India’s population and of these 127 million are between 0-5 years[2]. The infant mortality rate in India is 54 per 1000 live births[3] and the neonatal mortality is 39/1000 live births[4]. 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[5]. 45.9% of Indian children under three are underweight. Nearly 80% of infants now have anaemia[6]. 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[7].

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...
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