Conference: Call to Action - Child Survival and Development for Every Child in India


Blog: New Promise for India

By Vaibhav Gupta

When better is possible, good is not enough.

This message from PMNCH co-Chair Anuradha Gupta, Additional Secretary and Mission Director, National Rural Health Mission (NRHM), Ministry of Health and Family Welfare, best captured the spirit of India’s child survival summit last week. Despite the country’s phenomenal progress in curbing child and maternal mortality (from 1990-2010, India’s under-five mortality rate declined faster than the global average), the nearly 400 delegates who descended on Chennai from 7-9 February made it clear they will not be resting at this critical juncture; not while India continues to lose nearly 1.5 million children under the age of five every year.

The Government of India organized this “Call to Action for Child Survival and Development” summit as a follow-up to the “Global Child Survival Call to Action: A Promise to Keep” gathering it co-hosted with the Government of Ethiopia last June in Washington, D.C., in collaboration with USAID and UNICEF. The event followed on the heels of last month’s “Africa Leadership for Child Survival” meeting in Addis Ababa, where 20 African countries agreed on their own set of targets for child survival.

Ministers from central and state governments, leaders from the private sector, civil society, media and multilateral organizations, academia and funding agencies came together in Chennai to transcend beyond discussion and debate; to chart a future course of action for India, centred around a new roadmap entitled a “Strategic Approach to Reproductive Maternal Newborn Child and Adolescent Health” (RMNCH+A).

India's new plan for child survival

The plan centres on the continuum of care concept, which recognizes children’s health as closely linked to women’s health, from pre-pregnancy to delivery, to the immediate postnatal period, and into childhood. At a session on the final day of the summit, Ms Gupta commended PMNCH for promoting this philosophy and strengthening its practice, saying that “the Partnership has done a commendable job in bringing the focus back on the ‘continuum of care’ approach, and integrating the different components within it.”

The RMNCH+A strategy has taken stock of the evidence available, and the challenges India faces in further reducing child mortality and promoting child health. India will now focus its resources on targeting high-focus areas and vulnerable populations (newborns, girls, and tribal groups). More attention will be paid to high-burden districts, signalling a move away from a national level framework. States that are struggling will be given more support by the central government.

The new strategy articulates not only what needs to be done, but also how it is to be done based on hard evidence. At the summit, participants were witness to the release of the scorecard system. A new initiative to monitor progress across RMNCH+A interventions, the scorecard uses India’s Health Management Information System (HMIS) and national survey data. Several other tools have been developed and new programmes launched to aid the states in critical areas such as human resources. A “Child Health Screening and Early Intervention” service under NRHM, a “Maternal and Newborn Health Toolkit,” and plans to overhaul the nursing education system in the country were announced.

Committed to action

By the end of the summit, it became evident that the RMNCH+A roadmap is not just another document, but a clear vision backed by political commitment of the Government of India, and driven by the tremendous energy of the senior leadership within the Ministry of Health. Health Minister Ghulam Nabi Azad emphasized the crucial role for state governments in partnering with the central government to achieve important outcomes. He was candid in his call for shared responsibility among all levels, declaring categorically that “unless we have accountability, we cannot proceed further.” Moreover, he stressed that this applies to all the stakeholders involved, and not just the government.

Last year the government called for the creation of a secretariat for a multistakeholder coalition that would oversee the implementation of its national RMNCH+A plan. PMNCH board member Rajiv Tandon, Save the Children India’s senior health advisor, is the secretariat’s coordinator. On behalf of the civil society sector, Dr Tandon made a pledge at the summit in Chennai to drive advocacy for evidence based action to reach the unreached with essential interventions.

At the request of the Indian government, Save the Children has completed a review of credible civil society and faith-based organizations in India’s eight poor-performing states and 264 high-burden districts. The “map” will be uploaded to the National Rural Health Mission’s website.

Room for improvement

There is consensus that to meet Millennium Development Goal (MDG) 4 – a reduction of under-five mortality by two thirds between 1990 and 2015 – India will have to do a better job of preventing newborn deaths. More than 50 per cent of under-five deaths take place in the neonatal period, with the first week of life proving to be particularly challenging. Adolescent health is another area of concern. Gender discrimination continues to pose problems for India. Dr Vinod Paul, Head of the Department of Paediatrics, All India Institute of Medical Sciences urged the gathering to “get sick newborn girls to facilities” arguing that it would be a game changer for India. “Adolescent girls, is clearly one of the new areas we have to pay attention to,” said Dr Jose Martines, WHO. Others focused on the importance of women’s education and gender-sensitive communication strategies. Geeta Rao Gupta, UNICEF Deputy Executive Director, highlighted evidence surrounding the relationship between mothers’ education and birth spacing. Nandana Sen, a child rights activist, advocated for mainstreaming gender focus in communications for behavioural change. These positions are aligned with the strong equity focus of the RMNCH+A strategy.

Several speakers at the summit highlighted specific challenges and opportunities for India. Ms Gupta insisted that communities have to be empowered if the country wants to make great progress. This was supported by others, some of whom argued that given the volume of systems and processes that need to be monitored in India, it was impossible to achieve good results without involving communities to ensure accountability. Mickey Chopra, Chief of Health, UNICEF, spoke of the importance of closing the gap between ideal and typical uptake of essential interventions if we are to make significant progress in reducing child mortality. While we have been relatively successful in technological innovation, we have had limited success in process innovation, he argued. Several speakers talked about the importance of nutrition, water, and sanitation in India. Victor Aguayo, Nutrition Chief, UNICEF, said that states with higher prevalence of use of nutrition interventions had lower levels of malnutrition. Thomas Clasen from the London School of Hygiene and Tropical Medicine, urged action, stating that “India is ground zero for water and sanitation.”

Role for private sector

Quite fittingly, the penultimate session at the summit was entitled “Partnership for Improved Maternal and Child Health.” Opening the session, Ms Gupta declared that “in light of new challenges, we need to re-evaluate traditional partnerships.” She spoke of the opportunities presented by building relationships with the private sector and the importance of legislation in this process: “To build any effective partnership, we really need to build trust.”

Other speakers highlighted the distinct core competencies that the private sector can bring to women’s and children’s health, and the role different types of private sector companies can play. Gary Cohen, CEO MDG Health Alliance, said that “the private sector’s role should not be homogenous,” and further noted that the private sector has shown keen interest in engaging with the Government of India through a framework that incorporates corporate social responsibility, technology and development, market-based approaches, and stakeholder engagement. Carole Presern, Director, PMNCH, spoke about the importance of PMNCH as a platform for partners to discuss collectively what to do in India. She also reaffirmed the Partnership’s commitment to working with the Government of India in facilitating conversations with different partners. Technology and social media platforms were cited as critical enablers by other speakers. At the close of the summit, private sector and civil society representatives presented commitments to the Call to Action.

Inspiring hope

Several speakers expressed confidence that India can achieve what it has set out to do through the RMNCH+A strategy document. Nancy Powell, United States Ambassador to India, said that “polio success has shown what India is capable of.” Anuradha Gupta brought attention to the 7.25 per cent annual average decline in India’s child mortality from 2008-10.

I left Chennai hopeful, and with a great degree of confidence, that India will meet the goals it has set itself for 2015. Doing so would be quite an inspiration for international child survival efforts. The country accounts for nearly 25 per cent of deaths of children under five worldwide. Its success is critical, not just for its women and children, but for the whole world if we are to achieve MDG 4 at the global level.