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Sundarbans Health Watch - Series 1: How healthy are the children of the Indian Sundarbans?
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Sundarbans Health Watch - Series 1: How healthy are the children of the Indian Sundarbans?

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Professor Barun Kanjilal of IIHMR and the FHS India team outlines findings from the first Sundarbans Health Watch. The findings are from several in-depth studies into the health situation of children …

Professor Barun Kanjilal of IIHMR and the FHS India team outlines findings from the first Sundarbans Health Watch. The findings are from several in-depth studies into the health situation of children in a representative block of the Indian Sundarbans -- Patharpratima. The full report is available on the FHS website -- www.futurehealthsystems.org.


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  • KAKDWIP SDH
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    • 1. www.futurehealthsystems.org Minimum Size X : 15mm X Minimum Size X : 15mm X IDS_Master Logo IDS_Master Logo_Minimum Size
    • 2. www.futurehealthsystems.org How healthy are the children of Indian Sundarbans? The First Health Watch report 1st August, 2013
    • 3. 2 What Future Health System (FHS) research initiative wants to do? • Generate and push streams of evidences on the health service delivery system in the Sundarbans especially for children. • Create a knowledge platform to generate new ideas on how to provide better health services to disadvantaged children • Strengthen capacity of interested partners (govt, non-govt, and development agencies) to design and evaluate new interventions. • The first Health Watch report, based on a series of recent studies, is a step towards this direction.
    • 4. 3 • To generate knowledge on - The child health needs - Gaps in protecting child health rights - The barriers to access of health care services for children • Find out ways by which health care system can be made more effective in the Sundarbans Focus of the report
    • 5. 4 • Primary data collected from one block (Patharpratima) through  Household survey (focused on children)  Facility assessment  Exit interviews  RMP interview  Ethnographic studies and case studies • GIS mapping of all providers • An earlier FHS report on Sundarbans (2009) based on data from all 19 blocks. Data
    • 6. 5 Sundarban Patharpratima Sundarban (19 blocks) Patharpratima block
    • 7. 6 • 4.5 million people • Subsistence agriculture and forest /river products • Chronic poverty with dualistic development • Difficult to access • Man-nature conflict • Environmental threat The human face of the Sundarbans
    • 8. www.futurehealthsystems.org Key findings-I Child health status
    • 9. 8 1. Under-nutrition prevails at high level Indicator Moderate or Severe Severe Under weight (%) 38.6 12 Stunting (%) 35.2 11.7 Wasting (%) 25.2 8.6 The prevalence of stunting may be as high as 60% if the child is a girl, aged 1-3 years, and born in a poor household
    • 10. 9 Predictors of undernutrition Mother’s health Geography 0 10 20 30 40 50 %ofchildren Deltaic Non-deltaic 41.5 34.3 24.5 0 10 20 30 40 50 <18.5 18.6 - 24.99 >25 %ofchildrenunderweight Mothers’ BMI 0 10 20 30 40 50 %ofchildren Poor Non-poor Food security
    • 11. 10 2.Extra burden of morbidity 7.8% 38.6% 5.4% 30.3% 6.7% 28.9% Diarrhea Fever Morbidity burden among 0 to 6 year children in the last 30 days (self-reported) West Bengal S24 Paraganas Sundarbans
    • 12. 11 Environment-linked ailments hold the major share RI 48% Gastro 14% Skin 5% Non- specifi c 15% Other 18% Distribution of cases based on reported symptoms RI 31% Gastr o 37% Other 32% Distribution of cases based on reported hospitalization
    • 13. www.futurehealthsystems.org Key findings-II Child health rights: from a child’s viewpoint
    • 14. 13 Right 1: My mother should have adequate health and nutrition when I am inside her Good progress in ANC, but low coverage of supplementary nutrition during pregnancy and PNC FHS 2012 FHS 2009-10 DLHS3 (WBENGAL) % who had ANC during pregnancy 98.6 95.7 96.1 % who had ANC in the first trimester 60 60.3 42.5 % that received PNC 50 23.8 56.9 % received supplementary nutrition during pregnancy 62 53.2
    • 15. 14 Right 2: I should be born in a safe environment and at a safe hand • About 53% of the births were delivered at home (last 5 years). The rate reduced to 46% in 2011-12. • Only 5% of home deliveries were assisted by qualified professionals. • 3 out of 4 illiterate mothers delivered births at home assisted mostly by untrained hands.
    • 16. 15 Right 3: I should receive very special care during the 1st month followed by full preventive care • At least a quarter of all children aged 1-12 months took births and spent the first week of their lives without any supervision from any health worker. • 87% of the children (12-23 months) were fully immunized, but timeliness needs attention.
    • 17. 16 Right 4: I should be fed according to the universally accepted good feeding practice 43% 40% 0% 10% 20% 30% 40% 0-12 months 34% 28% 0% 10% 20% 30% 40% 0-12 months % of children of age 0-12 months who were immediately breastfed after birth % of children of age 0-12 months who were exclusively breastfed for 5-6 months Boy Girl
    • 18. 17 Right 5: I should be taken to a ‘proper’ doctor when I am ill and require ‘treatment’. RMP Govt. Facilities Pvt. Qualified % of ailing children used the services of 85.1% 4.1% 6.4% Median Distance travelled (km) 1 3 12 Median Travel Time (min) 15 25 80 Median Out of pocket Expenditure (Rs) 220 460 550
    • 19. 18 Hospitalization • Hospitalization rate of children 5.4% (in a year) • 75% of them were admitted in public hospitals • But only 1/3rd of them were treated at local BPHC 18
    • 20. 19 Right 6: I should receive regular supplementary nutrition during my childhood. 59 51 77 25 46 44 72 25 58 56 81 25 Weighing every month Regular AWW Visit Registered Vit- A Supply % of children received services through ICDS (0- 2 years) Deltaic Non- Deltaic Total
    • 21. 20 Children 3-6 years: mostly irregular or non- user of ICDS services 20 Regular 39% Far off, 27% No company, 14% No use, 12% Other, 8% Irregular/never 61% WHY?
    • 22. www.futurehealthsystems.org Key findings-III Child health care: by whom, how much, and where?
    • 23. 22 Public health network is grossly inadequate for comprehensive child care • Sub-centres are adequate but mostly address preventive care • Number of PHCs and BPHC are inadequate, but more importantly, due to lack of critical inputs, not all of them properly function • Facilities are not adequately child focused
    • 24. 23 The parallel (underground) providers fills in the gap • Overwhelming dominance of RMPs in curative care • Easy availability, instant medicine, proximity, and people’s trust make them a formidable competitor
    • 25. 24 24 KAKDWIP SDH
    • 26. 25 25 BPHC (1) PHC (3) KAKDWIP SDH
    • 27. 26 26 BPHC (1) PHC (3) SC (65) KAKDWIP SDH
    • 28. 27Rural Medical BPHC (1) PHC (3) SC (65) RMP (376) No of persons per Govt. Doctor (>35000) No of persons per RMP (900) KAKDWIP SDH
    • 29. 28 Quality of care of RMPs: unregulated, questionable and often puzzling • RMPs: Up-to-date knowledge about modern medicines • But quite incompetent in diagnosis and rational use of drugs • 47% of RMPs could not correctly answer a single question (total 5 questions) about ‘how a newborn should be cared’. • They successfully hide their incompetency by making their clinical procedures visibly indistinguishable from that of qualified providers.
    • 30. 29 Many NGOs but too little for child health • About half of the NGOs working in Patharpratima are committed to health care (totally or partially) • But, except for a few nutrition care initiatives, child health is not really focused.
    • 31. 30 Unique geographical challenges compound the barriers to access health facilities • The deltaic topography makes it extremely difficult for the people to access health facilities. • People living in the remote islands have to depend on multi- modal transportation. • The costs in terms of time and transportation are often prohibitively high.
    • 32. Indrapur PHC Madhab Nagar BPHC Sitarampur Ghat Patharpratima Ghat Aswinimaity Ghat Kali bangal Ghat Chandmari Ghat By Road By Boat River cross Boat Ghat TIME: 70 MinutesTIME: 77 MinutesTIME: 107 MinutesTIME: 127 MinutesTIME: 147 Minutes Day Fare: 20 INR Night Fare: 450 INR Day Fare: 22 INR Night Fare: 550 INR Day Fare: 37 INR Night Fare: 800 INR Day Fare: 39 INR Night Fare: 1100 INR Day Fare: 46 INR Night Fare: 1200 INR TIME: 10 Minutes Day Fare: 7 INR Night Fare: 100 INR TIME: 100 Minutes Day Fare: 19 INR Night Fare: 2300 INR TIME: 115 Minutes Day Fare: 26 INR Night Fare: 2400 INR TIME: 147 Minutes Day Fare: 46 INR Night Fare: 1200 INR
    • 33. 32 Climatic shocks trigger ill health and malnutrition • Direct effects • Indirect effects  Loss of livelihood  Migration of male members  Alternative livelihood seeking by mothers
    • 34. 33 Summary: the gaps • Basic (quality-assured) curative care • Nutritional care – institutional and at home • Neonatal care - institutional and at home • Referral linkage 33
    • 35. 34 Way forward…. • Bring Child Focused Lens in public health Programs. • Effective partnerships with development agencies and Non-state actors. • Stimulating, identifying and up scaling innovative health programs using low-cost modern technology. • Providing usable scientific evidence for better decision making. 34
    • 36. 35 Special thanks • Riddhi Uddalak • Sabuj Sangha • Mr. Dilip Ghosh, Ex Special Secretary, DoHFW • Dr. M N Roy, Ex Principal Health Secretary, DoHFW • Terre Des Hommes, Save the Children, CRY • Health officials of District South 24 Parganas and Patharpratima block • People and many other organizations of the Sundarbans
    • 37. 36 THANK YOU

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