1. Millennium Development goals Arnab Paul PU 5502 International Health 1

2. Outline Introduction: India's demography, health systems and data The Millennium Development Goals(MDG). MDG 4 and Indicators Trends and data Policy and programmes Challenges Recommendations and Conclusion 2

3. Introduction The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world's main development challenges, the focus being the human dimension. The MDGs are drawn from the actions and targets contained in the Millennium Declaration that was adopted by 189 nations. 3

4. Goal 4 Reduction of child mortality by two thirds, between 1990 and 2015 Indicators Under-five mortality rate Infant Mortality rate Proportion of 1 year-old children immunised against measles. 4

5. TARGET .. which will have to be achieved by 2015, is nearly 42 per 1000 live births. The trend for projecting estimates for 2015 suggest India is likely to fall short of the U5MR level of 42 by about 28 percentage points 5

6. Under 5 Mortality Rate 1998-99. Inter state variation Source : MDG COUNTRY REPORT 2009 6

7. Under 5 Mortality rate 2005 -06..Inter state variation Source : MDG COUNTRY REPORT 2009 7

8. Infant mortality rate IMR 80 per thousand live births in 1990 IMR reduced to 53 in 2008. Target to reduce IMR to 26.7 per thousand live births by 2015. Projections If trend continues, can only take India to an IMR level of about 46 by 2015, short of the target by 20. High rate of infancy deaths in India is largely attributed to very high share (66% in 2007) of neo‐natal deaths. 8

9. Infant mortality rate.. Trend 9

10. Early Childhood Mortality Rates More than half of deaths to children who die in the first five years of life occur in the first month after birth 10

11. MDG India Country Report 2009 11

12. MDG India Country report 2009 12

13. Determinants of child mortality in India Disease Diarrhoea Acute respiratory infection (ARI) ~ 30 % child deaths Vaccine Preventable disease Malnutrition 79.2 % of under 3 year olds suffer from Iron Deficient Anaemia ( Source : National Family Health Survey III, 2005-06 ) 13

14. One Year Olds Immunised against Measles 14

15. Immunisation Coverage 1992-93 ... 42 % 2007-08... 69.6% Projected By 2015 ~ 97 % However 4 big states,like Bihar, Chattishgarh, Rajasthan, U.P will only be able to cover 60 % going by its current pace. 15

17. Less than half of children age 12-23 months are fully vaccinated

18. Vaccination coverage has improved in most states, but there has been a notable decrease in vaccination coverage in several states16

19. Government Policy and programs Universal Immunisation program 1985 Diarrhoeal Disease Control Program Acute Respiratory Infection Control Program ¬ merged with Child survival and safe motherhood program 1992 Reproductive and child health program ( RCH )launched in 1997, second phase launched in 2005 17

20. Current Issues and Challenges Limited Resources * India spends only 5% of GDP on healthcare. Ineffective primary health care delivery Poor health care financing Poverty Poor health information management and data collection 18

21. Recommendation Health intervention programmes should focus on illiterate mothers and on households that are poor. Since, immunization of pregnant women against tetanus has a substantial effect in reducing neonatal mortality. Family health programmes should be strengthened to provide this basic health-care service to all pregnant women. 19

22. Recommendation Girls experience a higher level of child morbidity and mortality ¬¬ Eliminating gender differences in mortality rates would significantly reduce infant and child mortality overall The educational level of mothers tends to have a strong effect on the mortality of young children, as discussed in the NFHS report Pandey et al. (1998) 20

23. Recommendation Number of major interventions required improved access to antenatal, neonatal care Immunization nutritional supplementation Increasing the literacy rate among the female child. Targeting interventions 21

24. Conclusion By 2015 U5MR – will be short by more than 28 IMR - will be short by more than 20 India can achieve 97 % immunization coverage and more by 2015 if the current trend continues with adequate political will, funding and strategic implementation of policies and programmes. 22

25. Thank You ! 23