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Barriers to Implementation of a Childhood
Pneumonia and Diarrhoea Program
Dr Prabir Ranjan Moharana
MD(Community Medicine),PGDHHM.
Causes of Neonatal Deaths in India
Source: Liu et al, Lancet 2012 : Statistical Report
Distribution
of neonatal
deaths by
time since
birth
Global Under-5 Mortality(WHO-2008)
Malnutrition
Understanding Epidemiology of
Under-5 Deaths in India
 Role of Socio-cultural Factors (Exclusive Breast Feeding,
Complementary Feeding, Under-5 Malnutrition)
 Environmental Condition(Drinking Water Quality, Monitoring of
water quality, Safe Water & Sanitation, Indoor and Outdoor Air
Pollution)
 Behavioral Factors (Personal Hygiene, Ambient Air Pollution,
Parental Smoking)
Understanding Epidemiology of
Under-5 Deaths in India
 Equity in Healthcare Services(Gender, Caste, Religion, Female
Literacy, Economic Status, Accessibility etc)
 Preparedness and Capacity of Health System (Community and
Facility Level, Inter-sectoral Coordination between Health, ICDS, PRI
and PHED, Health <=> Economic Development, Doctor-Population
Ratio, Doctor-Nurse Ratio, Population-Bed Ratio, FLW-Population Ratio )
Understanding Epidemiology of Under-
5 Deaths in India
 Political Environment: Viable, Stable & Conducive Political
system, Political Will and Political commitment for social and
economic development, Allocation of adequate resources for
health, Proportion of GDP spent on health related activities i.e.
i. Drinking Water Supply, ii. Basic Sanitation, iii. Housing,
iv. Nutrition, v. Community Development, vi. Primary Health care.
 Role of Health, Nutrition and Environment Policies.
Changes that Government can make to
address these barriers.
 Robust Implementation of Policies and Programs of Departments of
Health, Women & Child Development(ICDS), PHED, PRI and
Environment.
 Formulation of New State Specific Policies if needed for Better Health
& Nutrition of under-five children of the state(eg. Bal Kuposhan Mukt
Bihar by Govt. of Bihar).
 More inter-sectoral convergence in different platforms like VHSND.
 Increasing quality of Community and Facility Based child health care.
 Involving Formal and Non-formal Private Providers for Prevention &
Treatment of Pneumonia and Diarrhoea.
Changes that Government can make to
address these barriers.
 Strategic Communications for more awareness about Pneumonia and
Diarrhea and IEC and BCC activities.
 Alignment with Global Action Plan for Prevention and Control of
Pneumonia and Diarrhoea(Prevention, Promotion & Treatment Framework)
Prevailing Global Challenges
1. Quality of Care at Facilities for
Pneumonia & Diarrhoea.
2. Quality of Care in Communities for
Pneumonia & Diarrhoea.
What drives Quality of Care in UP context?
Programs and Guidelines (Latest)
Infrastructure, Equipment & Commodities (Appropriate &
Adequate and Functional & Ready-to-Use)
Human Resources (Adequate in Number & with Appropriate
Skills)
Training & Competencies (trained service provider as per level of
facility)
Prompt Service Delivery (cost effective)
Quality of care (technically correct treatment as per level of facility)
Translation of Skills into Practice
Accountability and Commitment
Quality of Care in Communities for
Pneumonia & Diarrhoea.
 Strategic Communication for Behavioural Changes, Care Seeking
Behaviour, Community Awareness for Pneumonia, Diarrhoea and
treatment facilities.
 Strategic Communications by FLW during home visits.
 Training and Capacity Building of FLWs for Early Identification,
Referral and Community Level Management(Respiratory timers,
Low Cost Pulse Oximeter, Syr Amoxicillin/Inj Gentamicin).
Childhood Pneumonia & Diarrhoea: Barriers to Implementation

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Childhood Pneumonia & Diarrhoea: Barriers to Implementation

  • 1. Barriers to Implementation of a Childhood Pneumonia and Diarrhoea Program Dr Prabir Ranjan Moharana MD(Community Medicine),PGDHHM.
  • 2. Causes of Neonatal Deaths in India Source: Liu et al, Lancet 2012 : Statistical Report
  • 6. Understanding Epidemiology of Under-5 Deaths in India  Role of Socio-cultural Factors (Exclusive Breast Feeding, Complementary Feeding, Under-5 Malnutrition)  Environmental Condition(Drinking Water Quality, Monitoring of water quality, Safe Water & Sanitation, Indoor and Outdoor Air Pollution)  Behavioral Factors (Personal Hygiene, Ambient Air Pollution, Parental Smoking)
  • 7. Understanding Epidemiology of Under-5 Deaths in India  Equity in Healthcare Services(Gender, Caste, Religion, Female Literacy, Economic Status, Accessibility etc)  Preparedness and Capacity of Health System (Community and Facility Level, Inter-sectoral Coordination between Health, ICDS, PRI and PHED, Health <=> Economic Development, Doctor-Population Ratio, Doctor-Nurse Ratio, Population-Bed Ratio, FLW-Population Ratio )
  • 8. Understanding Epidemiology of Under- 5 Deaths in India  Political Environment: Viable, Stable & Conducive Political system, Political Will and Political commitment for social and economic development, Allocation of adequate resources for health, Proportion of GDP spent on health related activities i.e. i. Drinking Water Supply, ii. Basic Sanitation, iii. Housing, iv. Nutrition, v. Community Development, vi. Primary Health care.  Role of Health, Nutrition and Environment Policies.
  • 9. Changes that Government can make to address these barriers.  Robust Implementation of Policies and Programs of Departments of Health, Women & Child Development(ICDS), PHED, PRI and Environment.  Formulation of New State Specific Policies if needed for Better Health & Nutrition of under-five children of the state(eg. Bal Kuposhan Mukt Bihar by Govt. of Bihar).  More inter-sectoral convergence in different platforms like VHSND.  Increasing quality of Community and Facility Based child health care.  Involving Formal and Non-formal Private Providers for Prevention & Treatment of Pneumonia and Diarrhoea.
  • 10. Changes that Government can make to address these barriers.  Strategic Communications for more awareness about Pneumonia and Diarrhea and IEC and BCC activities.  Alignment with Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea(Prevention, Promotion & Treatment Framework)
  • 11.
  • 13. 1. Quality of Care at Facilities for Pneumonia & Diarrhoea. 2. Quality of Care in Communities for Pneumonia & Diarrhoea.
  • 14. What drives Quality of Care in UP context? Programs and Guidelines (Latest) Infrastructure, Equipment & Commodities (Appropriate & Adequate and Functional & Ready-to-Use) Human Resources (Adequate in Number & with Appropriate Skills) Training & Competencies (trained service provider as per level of facility) Prompt Service Delivery (cost effective) Quality of care (technically correct treatment as per level of facility) Translation of Skills into Practice Accountability and Commitment
  • 15. Quality of Care in Communities for Pneumonia & Diarrhoea.  Strategic Communication for Behavioural Changes, Care Seeking Behaviour, Community Awareness for Pneumonia, Diarrhoea and treatment facilities.  Strategic Communications by FLW during home visits.  Training and Capacity Building of FLWs for Early Identification, Referral and Community Level Management(Respiratory timers, Low Cost Pulse Oximeter, Syr Amoxicillin/Inj Gentamicin).