Child Survival among Urban Poor- Challenges and Approaches for Involving Pediatricians

Transcription

1 Child Survival among Urban Poor- Challenges and Approaches for Involving Pediatricians IAP Central Zone Workshop February 9th, 2006 Shreemaya Residency, Indore Dr. Siddharth Agarwal Urban Health Resource Centre

2 Unabated Growth of the Urban Poor phenomenon of population growth Urban population million Urban poor estimated at million Estimated births among urban poor 2.6 million Expected population as of 2006 based on 200 Census of India and 3% growth rate in urban areas NSSO (55 th round) using 30 day recall of consumer expenditure. 3 Lawrence Haddad, Marie T. Ruel, and James L. Garrett, 999. Are Urban Poverty And Under-nutrition Growing? Some Newly Assembled Evidence. 4 Calculated based on Total Fertility Rate of 3.0 for urban poorest quintile from Laveesh Bhandari and Shruti Shresth, Health of the poor and their subgroups in Urban areas, June 2003.

3 Poor Child Health and Survival among Urban Poor in India Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages Under 5 Mortality * Infant Mortality * Neonatal Mortality * Malnutrition** Rural Average * Mortality per 000 live births Urban Average Urban Poor ** Weight for age <-2 SD [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

4 Poor Access to Health Services Complete ANC (3ANC+IFA+TT) Home deliveries Rural Average Urban Average Urban Poor Nearly.5 million babies are born every year in slum homes [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

5 Poor Access to Health Services Complete Immunization by age 2-23 months Rural Average Urban Average Urban Poor [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

6 Sub-optimal Health Behaviors Rural Average 0 Breastfeeding Initiation within hr Initiation of Complementary Feeds by 7mths Urban Average Urban Poor [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

7 Mortality rates among Urban Poor in MP are far higher than all India average Under 5 and Neonatal Mortality among urban poor Under 5 Mortality Rate MP All India Neonatal Mortality [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

8 Urban Poor in MP vs India Nutritional Status and Access to Health Services Nutritional Status and Access to Health Services Underweight (-2 SD) Complete immunization ORS usage MP All India [Re-analysis of NFHS 2 (998-99) by Standard of Living Index, UHRC (formerly EHP): 2003]

9 Approaches for involving Pediatricians

10 PPP: Approach # contd. Part-time Outreach Services to slums by Pediatricians Socially Committed Private Doctor [receives honorarium from Govt] (about 3-4 hrs every Sunday) Week Week 3 Slum 3000 popln Slum popln Week 2 Nodal Govt./Municipal Dispensary.Vaccines 2.Other supplies 3.Coordination 2 nd tier Govt./Private Centre Referral from slums to Govt. Dispensaries or 2 nd tier Govt/Private centre Week 4 Slum popln Slum popln Social Mobilization by NGO Identifies and trains link workers Supports community mobilization Supports outreach services Builds linkage between community, health providers District Urban RCH Unit Coordinates with private doctors, NGOs, nodal Dispensary, Coordinates periodic review Under the govt. immunization scheme there is provision of Rs. 400 for 4 camps to be held in a slum per month

11 Indicative Monthly budget: Part-time outreach services to slums by pvt. Doctor Unit Cost Line items Qty Time frame Rate Total Budget (Rs.) A. Personnel Cost (a) Part time Doctor 4 days , NGO Staff for community mobilization (a) Project coordinator (full time) month , (b) Social Mobilizer (full time) month 5, , (c) Link Volunteers ( for 500 population i.e. 2 for every slum cluster; no. of slum clusters -4) 8 month 500 4, personnel cost 8, B. Travel (a) Project coordinator's travel Rs.70/- per day * 0 days 0 days (b) Social mobilizer's travel Rs.70/- per day * 8 days 8 days 70, (c) Mobility support (fuel per camp) for outreach camps 4 days 500 2, Travel 3, C. Misc Total ,000.00

12 PPP: Approach #2. contd Other forms of Partnership with Private Doctors Private doctors can provide health services in government health facilities on fee sharing/part time basis. [E.g. IPP VIII Kolkata and Delhi (Arpana)] Govt. referred cases (neonates, childhood illnesses) are treated at Private facility which can be then reimbursed. [e.g. TN] Govt. can give child health vouchers to parents of newborns for series of services they can avail at private doctor s facility [Kolkata, Udaipur] Once-a-week-OPD subsidy: Private Pediatricians (and others) can provide substantially subsidized services for the poor once a week for a specified time at their clinics

13 PPP Approach # 2 Potential role of IAP and other professional bodies Technical and advocacy related partnership IAP city chapters can provide training e.g. IMNCI Plus training to MOs, ANMs, Link Volunteers (ASHA) Advocacy for enhanced attention to Urban Health among Govt. and corporate sector Advocacy among IAP members to provide weekly outreach services in slum Dept. of pediatrics in medical colleges can undertake slum based child survival and development researches Partner with Govt for expanding maternal & child health services to un-reached urban poor clusters

14 PPP Approach # 2 contd IAP Partnership with government for expanding services District Coordinates Urban periodic RCH Unit review Coordinates Vaccines Supplies Referral support Coordination IAP City Chapter (funded by govt.) PPP In-charge Medical & Nursing Team Social Mobilizer [Full time] Reporting IAP members with their nursing staff provide out reach services for 6 hours every Sunday Social mobilizer Identifies and trains link workers Supports community mobilization Supports outreach services Serves as link between community, health providers and IAP Slum 4000 popln Slum popln Slum popln Nodal Government Urban Dispensary ( st Tier Centre) Referrals from slums to Govt. Dispensary or 2 nd tier Govt/Private Centre Slum popln Private / Govt. 2 nd tier hospital Outreach services include treatment of minor illnesses, ANC, immunization, health counseling

15 Indicative monthly budget for IAP-Govt. partnership Unit Cost Line items Qty Time frame Rate Total Budget (Rs.) A. Personnel Cost Medical and nursing team (a) Doctor (part time) 4 days , (b) Auxiliary Nurse Midwive (part time) 4 days , Staff for community mobilization (a) Social Mobilizer (full time) month 6, , (b) Link Volunteers ( for 500 population i.e. 2 for every slum cluster; no. of slum clusters -4) 8 month 500 4, Mgt. and Supervision support (a) PPP incharge month 8, , personnel cost 2, B. Travel (a) Social mobilizer's travel Rs.70/- per day * 8 days 8 days 70, (b) Mobility support (fuel per camp) for outreach camps 4 days 500 2, Travel 3, C. Misc 2340 Total Siddharth Agarwal (2006). Child Survival among Urban Poor- Challenges and Approaches for involving Pediatricians. Presentation made at IAP 33, Central Z

16 Enhanced community health benefits through IAP s Partnership with NGOs Quickly expand access to child health services in slums without delays entailed in creating new infrastructure Better quality and expanded range of services Better identification and targeting of vulnerable population by NGOs Improved community-provider linkage and timely referral

17 Urban Slum Specific Pediatric Concerns Practice Related Pediatricians can promptly report initial cases of preventable diseases in slums such as measles, gastroenteritis IAP could act as a pressure lobby to initiate immediate action to prevent an outbreak Most infant deaths are preventable malnutrition and diarrhea are most common contributing factors - pediatricians have a key role in institutional and community based nutrition rehabilitation - by providing counseling on hygiene behaviors through pictorial cards or other means pediatricians can ensure prevention of food and water borne diseases Research Related Need to identify geographic areas for investigatory research based on reported cases of under-nutrition and mortality from slums [E.g. Pathway to child survival study]

18 IAP s Partnership with Media

19 IAP s Partnership with Media An important partner for awareness and change Media can create social uproar to influence politicians, other Govt. departments, corporate and highlight plight of urban poor children such as malnutrition, unsafe deliveries, lack of immunization Can document and disseminate best practices from working models to encourage and inspire others e.g. SPARC-Mahila Milan, Streehitkarini, SNEHA (all Mumbai), Sumangli Sevashram Bangalore Can partner for promoting health behaviors by generating non-technical, audience friendly messages on immunization, breast feeding etc. Examples of effective partnering with media include Pulse Polio Campaign, HIV/AIDS Awareness, Anti-Smoking Campaigns. Regional language media and radio channels reach and appeal among the masses; city chapters of IAP can provide support to regional media in developing messages on identified themes IAP can conduct sensitization workshops for editors and sub editors, who are key decision makers on issues to be published/ telecast among competing non health issues

20 Let us work together to enable slum communities to build a healthy and productive tomorrow