Child Health
The unique vital rate surveillance system
Established in 1986, this is a census system carried out once in five years and every six months. The information collected includes socio demographic information of 86 villages and data of births and deaths of children upto 5 years age. Since 2002, information on deaths beyond age of 5 is also being collected. The data base is unique in that it not only contains record of births and deaths of <5 children but also the causes of death as determined by using verbal autopsy tool developed by SEARCH. (Bulletin of World Health Organization, 1992 )
Child mortality reduction in 39 villages of Gadchiroli district
These 39 villages are the laboratory of SEARCH where path breaking research has been carried out in the field of child health.
Under five child mortality reduction in 39 villages of Gadchiroli district
SEARCH achieved reduction of pneumonia specific case fatality through diagnosis and treatment of pneumonia in <5 children by trained Community Health Workers, as per diagnosis and treatment protocol developed by SEARCH (Lancet paper) This programme is operational since 1988.
From a value of 13.5% in 1988, the pneumonia case fatality was reduced to 0.8% within two years and has been pegged down at that level till now. The IMR consequently reduced from 121 to 80 by 1990.
NMR and IMR reduction
Identifying major contribution of newborn mortality to residual IMR, SEARCH developed Home based Newborn Care (HBNC) model and achieved drastic reduction in IMR. From a high of 121 in 1986 Home-Based Newborn & Child Care (HBNCC) progressively reduced IMR to a level of 30 by 2003.
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Replicability and scalability of HBNC
THE ANKUR project (2001 to 2006) conducted in the state of Maharashtra by SEARCH and its 7 NGO partners which achieved a 51% reduction in IMR and also the study conducted by ICMR in 5 states of India proved that the HBNC model was replicable and that community health workers could be successfully trained to provide HBNC.
Change in policy on child health nationally and internationally
The results of ANKUR project, the conclusions drawn from ICMR study as also the successful replication efforts in Nepal (MINI project); Bangladesh (Prajhmno project), Pakistan (HALA project) and other successful adoptions of HBNCC resulted in acceptance of newborn care by community health workers nationally and internationally. Thus, a joint statement was issued by WHO, UNICEF and Save the Children US recommending newborn care by community health worker wherever necessary. Government of India under NRHM made HBNC part of module 6 and 7 of training of ASHAs, the community health worker cadre created in India to enable them to provide HBNC services.
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Present status of replication of HBNCC
Presently HBNC has been replicated in 23 Indian States and 4 developing countries
Child death as human rights issue
SEARCH has relentlessly taken up Child Death as a human rights issue. The underreporting of child deaths by the health system of Government of Maharashtra was exposed by SEARCH through a study in 13 sites in Maharashtra. The report was first published in November 2001 in Marathi, aptly titled “Kovli Pangal” and later as a scientific paper in Economic and Political weekly (December 7, 2002). The partners of SEARCH in this study were members of the Child Death Study and Action Group (CDSAG). This not only had reverberations in the Maharashtra Health Assembly and forced the Government of Maharashtra to promise action and finally appoint a committee to study the problem of Child Deaths and Malnutrition in Maharashtra, under the chairmanship of Dr Abhay Bang, Director, SEARCH. This committee submitted a report bringing out the true status of the problem and suggesting remedial action. The study on underreporting of child deaths in Maharashtra was later published under the title “Hidden Child Mortality in Maharashtra” in 2006 with a foreword from the then Registrar General of India which was a tacit admission by him that underreporting was not only a reality of Maharashtra but probably was a nationwide phenomenon. Advocacy based on evidence and untiring efforts of SEARCH in projecting this issue in national and international for a finally resulted in Governments accepting solution offered by SEARCH in India(The module 6 and 7 of ASHA training and abroad as exemplified by acceptance in Ethiopia.
Kovli Paangal Hidden child mortality EPW paper,
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