The country accounts for 5000 child deaths every day.
Child mortality rates may have declined over the years. Yet, about 2 million children in India die every year before they reach their fifth birthday. In an attempt to address the major causes and the managerial challenges resulting in child mortality, a study by the Indian Institute of Management, Ahmedabad (IIM-A) brings out the nature and magnitude of child deaths in India.
The study also observes the various national programs of the government of India. For instance, India launched the Universal Immunization Program in 1985, but the status of full immunization in India has reached only 43.5 per cent by 2005-06. India started the Integrated Child Development Scheme (ICDS) in 1975 to provide supplementary nutrition to children, but 50 per cent of our children are still malnourished; nearly double that of Sub-Saharan Africa. The WHO/UNICEF training program on Integrated Management of Neonatal and Childhood Illnesses, known as IMNCI, started in India a few years ago, but the progress is very slow, the study states.
The study titled— Why Should 5000 Children Die in India Every Day? Major Causes and Managerial Challenges has been conducted by KV Ramani, Dileep Mavalankar, Tapasvi Puwar and Sanjay Joshi from the Centre for Management of Health Services (CMHS) at IIM-A along with, Harish Kumar, intern from Tata Institute of Social Sciences, Bombay and Imran Malek, intern from SRM University, Chennai.
Child health is usually described across three commonly used indicators: Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR), and Under-5 Mortality Rate. India's neonatal mortality, which accounts for almost 2500 out of 5000 under five (U5) deaths every day, is one of the highest in the world, the study states. The study further says that the major causes of child death include neonatal disorders (death within 28 days of birth), diarrhea, pneumonia, and measles. Malnutrition accounts for almost 35 per cent of childhood diseases. India alone accounts for almost 5000 child deaths under 5 years old (U5) every day.
India's child heath indicators are poor even compared with our Asian neighbors, namely Malaysia, Sri Lanka, Thailand, Vietnam, China, Nepal and Bangladesh. Within India, on the one hand, we have states like Kerala and Tamil Nadu which have excellent indicators of child health, comparable with those of many developed countries. On the other hand, we have states like Orissa, Madhya Pradesh, UP, Rajasthan and Bihar whose child health indicators are very poor. These 5 states put together account for almost 40 per cent of India's total population and 60 per cent of child deaths.
In order to combat child morbidity and mortality, the study recommends community based initiatives, which can extend the delivery of interventions in remote areas where health services are either non-existent or non-functioning. But such activities are not sustainable in the long run, it says. The long term aim should be to strengthen the national health system in developing countries, which requires substantial augmentation of management capacity.
While the management of maternal health programs requires medical interventions to bring down Maternal Mortality Ratio (MMR), the management of child health programs requires medical attention mainly to reduce Neonatal Mortality (NMR).
In order to achieve desired goals on child health, India has to achieve 7.6 per cent reduction in U5 mortality per year from 2009-2015, as against an annual achievement of only 2.6 per cent during the period 1990-2009. Management of child health programs needs much more attention through planning the allocation of resources, monitoring project activities and making timely interventions to bring the project under control, the study further recommends.
