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www.futurehealthsystems.org
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IDS_Master Logo
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www.futurehealthsystems.org
How healthy are the children of
Indian Sundarbans?
The First Health Watch report
1st August, 2...
2
What Future Health System (FHS)
research initiative wants to do?
• Generate and push streams of evidences on the health ...
3
• To generate knowledge on
- The child health needs
- Gaps in protecting child health rights
- The barriers to access of...
4
• Primary data collected from one block
(Patharpratima) through
 Household survey (focused on children)
 Facility asse...
5
Sundarban Patharpratima
Sundarban (19 blocks)
Patharpratima block
6
• 4.5 million people
• Subsistence agriculture and
forest /river products
• Chronic poverty with dualistic
development
•...
www.futurehealthsystems.org
Key findings-I
Child health status
8
1. Under-nutrition prevails at high level
Indicator Moderate or
Severe
Severe
Under weight (%) 38.6 12
Stunting (%) 35.2...
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
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...
11
Environment-linked ailments hold the
major share
RI
48%
Gastro
14%
Skin
5%
Non-
specifi
c
15%
Other
18%
Distribution of...
www.futurehealthsystems.org
Key findings-II
Child health rights: from a
child’s viewpoint
13
Right 1: My mother should have adequate
health and nutrition when I am inside her
Good progress in ANC, but low coverag...
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 (la...
15
Right 3: I should receive very special care
during the 1st month followed by full
preventive care
• At least a quarter ...
16
Right 4: I should be fed according to the
universally accepted good feeding
practice
43%
40%
0%
10%
20%
30%
40%
0-12 mo...
17
Right 5: I should be taken to a ‘proper’
doctor when I am ill and require
‘treatment’.
RMP Govt.
Facilities
Pvt.
Qualif...
18
Hospitalization
• Hospitalization rate of children 5.4% (in a year)
• 75% of them were admitted in public hospitals
• B...
19
Right 6: I should receive regular
supplementary nutrition during my
childhood.
59
51
77
25
46
44
72
25
58
56
81
25
Weig...
20
Children 3-6 years: mostly irregular or non-
user of ICDS services
20
Regular
39%
Far off, 27%
No company, 14%
No use, ...
www.futurehealthsystems.org
Key findings-III
Child health care: by whom, how
much, and where?
22
Public health network is grossly
inadequate for comprehensive child care
• Sub-centres are adequate but mostly address ...
23
The parallel (underground) providers fills
in the gap
• Overwhelming dominance of RMPs in curative care
• Easy availabi...
24 24
KAKDWIP SDH
25 25
BPHC (1)
PHC (3)
KAKDWIP SDH
26 26
BPHC (1)
PHC (3)
SC (65)
KAKDWIP SDH
27Rural Medical
BPHC (1)
PHC (3)
SC (65)
RMP (376)
No of persons per Govt. Doctor (>35000)
No of persons per RMP (900)
KAK...
28
Quality of care of RMPs: unregulated,
questionable and often puzzling
• RMPs: Up-to-date knowledge about modern medicin...
29
Many NGOs but too little for child health
• About half of the NGOs working in Patharpratima are
committed to health car...
30
Unique geographical challenges compound
the barriers to access health facilities
• The deltaic topography makes it extr...
Indrapur PHC
Madhab Nagar
BPHC
Sitarampur Ghat
Patharpratima Ghat
Aswinimaity Ghat
Kali bangal Ghat
Chandmari Ghat
By Road...
32
Climatic shocks trigger ill health and
malnutrition
• Direct effects
• Indirect effects
 Loss of livelihood
 Migratio...
33
Summary: the gaps
• Basic (quality-assured) curative care
• Nutritional care – institutional and at home
• Neonatal car...
34
Way forward….
• Bring Child Focused Lens in public health Programs.
• Effective partnerships with development agencies ...
35
Special thanks
• Riddhi Uddalak
• Sabuj Sangha
• Mr. Dilip Ghosh, Ex Special Secretary, DoHFW
• Dr. M N Roy, Ex Princip...
36
THANK YOU
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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 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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  • Transcript of "Sundarbans Health Watch - Series 1: How healthy are the children of the Indian Sundarbans?"

    1. 1. www.futurehealthsystems.org Minimum Size X : 15mm X Minimum Size X : 15mm X IDS_Master Logo IDS_Master Logo_Minimum Size
    2. 2. www.futurehealthsystems.org How healthy are the children of Indian Sundarbans? The First Health Watch report 1st August, 2013
    3. 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. 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. 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. 6. 5 Sundarban Patharpratima Sundarban (19 blocks) Patharpratima block
    7. 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. 8. www.futurehealthsystems.org Key findings-I Child health status
    9. 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. 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. 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. 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. 13. www.futurehealthsystems.org Key findings-II Child health rights: from a child’s viewpoint
    14. 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. 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. 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. 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. 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. 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. 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. 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. 22. www.futurehealthsystems.org Key findings-III Child health care: by whom, how much, and where?
    23. 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. 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. 25. 24 24 KAKDWIP SDH
    26. 26. 25 25 BPHC (1) PHC (3) KAKDWIP SDH
    27. 27. 26 26 BPHC (1) PHC (3) SC (65) KAKDWIP SDH
    28. 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. 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. 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. 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. 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. 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. 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. 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. 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. 37. 36 THANK YOU
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