Indian government pledges new resources to improve child survival

BMJ 2013; 346 doi: (Published 13 February 2013) Cite this as: BMJ 2013;346:f1003
  1. Ganapati Mudur
  1. 1New Delhi

India’s health ministry has announced plans to improve the health of adolescents and also to evaluate progress of states and districts on child survival under a fresh package of initiatives to reduce mortality among children under 5 years old.

The announcement, made at a summit on child survival held on 7 to 9 February in the town of Mahabalipuram, Tamil Nadu, has been hailed by international, non-governmental, and donor agencies.

But some paediatricians and public health experts have warned that future gains in child survival are likely to hinge on how India resolves certain lingering, contentious problems such as neonatal deaths and severe acute malnutrition.

At the summit the health ministry released documents that it said described “operational guidelines” to integrate adolescent health services with reproductive, maternal, newborn, and child health activities. The ministry also indicated that it would track child health services across the country and offer states incentives and disincentives, depending on their performance.

The initiatives are intended to reduce the death rate among children under 5 years from 59 per 1000 live births in 2010 to 33 per 1000 by 2017 and the infant death rate from 44 per 1000 live births to 25 per 1000 by 2017.

Ajay Khera, deputy commissioner for child health, said that the new focus on adolescents would contribute to overall child survival. “And the tracking system will help us identify those districts and populations that need urgent attention,” Khera told the BMJ.

The government has pledged to expand iron and folic acid supplementation to cover 130 million children and teenagers aged 10-19 years and to run educational campaigns to curb early marriage and pregnancy and encourage wider spacing of childbirths.

Chaitanya Bansal, president of the Indian Academy of Paediatrics and a delegate at the summit, said, “These steps are expected to lower the risks of preterm deliveries and low birth weight babies.”

The ministry estimates that India’s annual infant mortality figure includes about 880 000 deaths of newborns. “It’s unfortunate that our figures for early neonatal mortality have shown a very slow rate of decline,” Bansal told the BMJ.

The ministry supports a proposal to allow trained community health workers in rural areas to provide co-trimoxazole to severely ill newborns who cannot be moved even to the nearest clinic.

Abhay Bang, a physician and public health specialist with the non-governmental Society for Education Action and Research in Community Health in Maharashtra, said, “Such a programme could significantly reduce neonatal mortality. We have ample evidence this works on a small scale. The challenge will be to expand training and supervision of community health workers nationwide.”

Some doctors last year questioned the proposal to entrust community health workers with administering co-trimoxazole. But the health ministry asserted that this “first line treatment of neonatal sepsis” was intended to curb neonatal deaths.

Community health specialists and paediatricians believe that the government also needs to revise its current policies on managing severe acute malnutrition in young children to reduce child mortality.

State governments have established nutrition rehabilitation centres to treat for 14 days children who meet certain criteria for severe acute malnutrition.

But doctors said that current screening guidelines exclude a significant proportion of children who need urgent care.1 2 Vandana Prasad, a paediatrician in New Delhi who has studied the management of children with severe acute malnutrition, said that nutrition rehabilitation centres followed a “conveyor belt approach”—they “take in children [and] send them out in 14 days with little regard to whether they’re fit enough for discharge.”

Health officials estimate that about six million children have severe acute malnutrition. Khera said the health ministry is working towards improving management by strengthening community care.

Delegates at the summit praised the government for its new pledges. Rajiv Tandon, a paediatrician for the charity Save the Children, said, “I think we’ve seen unprecedented levels of enthusiasm at the political level. The [health] ministry has issued building blocks for action. It’s now for the states to tailor them for local needs.”


Cite this as: BMJ 2013;346:f1003