India renewing commitment to end child and maternal deaths
Aaapathyaam raksha garbhineem (may the pregnant woman and her child be saved from all dangers) is at the core of our Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) approach to child and maternal health under the National Health Mission. Our commitment to end all preventable child and maternal deaths through the public health delivery system is evident in the efforts made to strengthen processes, ensure quality care and expand our reach to every woman and child.
When the National Rural Health Mission (NRHM) was launched in 2005, it was envisaged to put in place systems and structures that would result in improvement in health outcomes across the states. Under the National Health Mission (NHM), states have been given resources to strengthen their last-mile health service delivery, improve health infrastructure, invest in training of health human resource and pilot innovative interventions to address state-specific health needs. Some states have been able to reap the benefits through NHM while others are in the process of meeting shared goals of health outcomes.
Maternal and child health has been the focus under the NHM. Remarkable success in meeting our goals in maternal and child health is attributed to NHM. India’s under-five mortality rate stood at 126 against the global average of 90 in 1990. In 2013, this figure dropped to 49 while the global average stood at 46. The significant reduction in the gap to the global average from 36 points in 1990 to just 3 points in 2013 reflects the fact that India has achieved the under-five mortality rate decline at a faster pace than the global rate. Moreover, the annual rate of decline during 2008-13 has been 6.6%. What this means is that if the current trend of annual decline of 6.6% is sustained, India is likely to reach close to achieving the Millennium Development Goals (MDGs).
The NHM also lays emphasis on a continuum of care for the newborn both at the community and facility levels. While 575 state-of-the-art special newborn care units have been set up at district-level public health facilities, more than 2020 newborn stabilisation units and 14,441 newborn care corners are functional at referral health facilities. At the community level, nine lakh trained Accredited Social Health Activists provide home-based care to promote improved newborn care practices and to detect early signs of danger for referral.
As a result of our focus on promoting and encouraging pregnant women to have safe delivery in health institutions, schemes such as Janani Suraksha Yojana (JSY) and the Janani Shishu Suraksha Karyakaram (JSSK) have ensured quality services for pregnant women and sick newborns in both rural and urban areas.
Under the former, incentives are given directly to the pregnant mothers for delivering in public institutions. The JSSK entitles every woman delivering in a public health institution to free and cashless health services with an assured provision of free drugs, diagnostics and diet besides free to and fro transport. This has resulted in an unprecedented increase in institutional deliveries from 47% (2006-07) to approximately 79% in 2013. This has reduced maternal mortality to an impressive 167/100,000 live births.
The achievements under Mission Indradhanush, one of the world’s largest immunisation drives to cover all unvaccinated and partially vaccinated children against seven vaccine preventable diseases, reflect our commitment towards ensuring that no child is left without the protection of full immunisation. During the first phase we have immunised additional 20 lakh children who had been left out in our routine process, and vaccinated about 21 lakh pregnant women. The mission has also resulted in strengthening health systems, in addition to an expanded basket of services to cover ORS packets, Zinc and Vitamin A tablets. In keeping with the global efforts to reduce newborn mortality, we launched the India Newborn Action Plan in September 2014 targeting reduction in Neonatal Mortality Rate and still births to single digit by 2030.
As the MDGs come to an end, India renews its commitment to end preventable child and maternal deaths to meet the new targets set under the Sustainable Development Goals. Our resolve is to ensure rapid and uniform progress in health across India. While systems are in place in large parts of the country, what is required today is to improve the performance of health systems by focusing on quality, accessibility and affordability of healthcare. In our quest to achieve these, we are guided by principles of equity, universality, patient centeredness, inclusive partnerships, accountability, professionalism, integrity and ethics.
It is indeed an honour that India has been given the opportunity to host the Global Call to Action Summit 2015 for ending preventable child and maternal deaths. I see it as an excellent opportunity to make a global impact by showcasing our remarkable achievements in the field of maternal and child health.
India has robust policies, cost effective and high-impact strategies and health interventions, and strong partnerships in place to ensure that our interventions reach all the women, newborns and young children who need them and improve health outcomes nationwide.
I also see the summit as a confluence where India can learn from other countries. India is ready to lead the way and commit to bold targets. Undoubtedly our mothers, our newborn babies and young children deserve the best.
JP Nadda is Union minister of health and family welfare. The views expressed are personal.