Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

J. Chang - India's Progress towards the health related Millennium Development Goals - Child MortalityChild MortalityMDG 4 aims to reduce the under-five mortality rate (U5MR)by two thirds by 2015. The U5MR is the probability of a childborn in a specific year dying before reaching the age of fiveand Goal 4 aims at reducing it from 125 deaths per thousandlive births in 1988-92 to 42 in 2015 3,4,5,6 . Though Indiamanaged to bring the U5MR down to 74.6 per thousand livebirths in 2005-06, estimates suggest that by 2015, India mightreach U5MR of 70 per thousand, falling considerably short ofthe MDG 4 target of 42 per thousand live births 2. Similarly,considering Infant Mortality Rate (IMR), the number ofinfant deaths in less than a year after birth, trends suggests thatIndia will be able to attain IMR level of about 46 per thousandby 2015, falling short off the target IMR of 26.7 per thousand7. In the following sections, an overview of measures takentowards attaining MDG 4 has been presented which isfollowed by a discussion of major challenges towardsattainment of MDG 4 and recommendations for possiblesolutions.Past measures:India was the first country in the world to launch a FamilyPlanning Program in 1951. Over time the program evolvedinto Reproductive and Child Health program whichcommenced in October 1997. The goals of the Reproductiveand Child Health program were to stabilize the population,reduce maternal and child mortality and morbidity andimprove their nutritional status. To this end, the programoffered several interventions to improve children healthwhich included a Universal Immunization Program, EssentialNewborn Care and Integrated Management of Neonatal andChildhood Illnesses (IMNCI) program. Due to theseinterventions, decline in the under-five mortality rate hastaken place throughout India and a more noticeable decline isseen in rural areas compared to urban areas. This trendimplies that the government's Universal Immunization andIMNCI programs are being successfully implementedthroughout the rural parts of India.Fig.1: Trend in Measles immunization in 1 year old children8(1990-2008)Present measures:9One-fifth of the world's children live in India. Therefore thecountry's ability to achieve goal 4 is very important to thegrowth and stabilization of the world's children population.There are three indicators measured in order to determine thereduction in under-five mortality rate: under-five mortalityrate, infant mortality rate, and proportion of 1 year oldchildren immunized against measles.In order to successfully reach this goal, the Indian governmentsigned a five-year action plan with UNICEF to promote thesurvival and well-being of its children. In August 2008,India's Minister of State for Woman and Child Developmentand UNICEF India launched the GOI-UNICEF Program ofCo-operation 2008-2012. The joint initiative is designed tohelp India achieve its national development goals while10ensuring that no child is left behind as India moves forward .The joint plan focuses on the reduction of India's infantmortality and maternal mortality rates (IMR and MMR),fighting malnutrition, tackling HIV, providing qualityeducation, ensuring safe water and environmental sanitationand providing child protection. This partnership seeks topromote the well-being and survival of India's children.Fig. 2: IMR and U5MR over the last 2 decades8(1990, 1995, 2000, 2005, 2008)The program wants to further reduce IMR from 58 to 28 per1,000 live births, and MMR from 301 to 100 per 100,000 livebirths within five years. The main interventions will focus onimproving access to immunizations, child survival andmaternal care and strengthening the current health care11infrastructure.In addition to this initiative, there are other initiativesunderway in India which seeks to help the country reach itsMDG-4 by 2015. The Child Environment program aims toimprove the availability of clean or safe water availability, itsmanagement, conservation and equitable allocation, as wellas access to sanitation and adoption of critical hygienepractices. Through this program the India's government hopesto create sustainable access to safe water and basic sanitationservices. The Children and AIDS program aims to decreaseIndian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 10