#1• . MANAV VIKAS MISSION-BIHAR 2013-17 and 2017-2022 (Population, Health, Malnutrition related issues) HEALTH SECTOR VISION & COMMITMENT Mission statement: Bihar Health, Population and Nutrition Sector will compliment the Manav Vikas Mission Goals by Identifying and providing solutions for implementation bottlenecks, Introducing out of the box interventions and processes for better outcomes Fast tracking of development of infrastructure and human resources Coordinating for improved intersectoral convergence Partnering with communities and strengthening community systems Optimal utilization of available resources#2• Achievements and Challenges The improved governance in Bihar in the last 7-8 years has led to an economic revival in the state through increased investment in infrastructure, better health care facilities, greater emphasis on education and a reduction in crime and corruption. Bihar's achievements in reducing maternal and child mortality in the recent past has been impressive, yet challenges still remain. Sr. Indicator No Latest Situation Trend 1 Infant Mortality Rate (number/1000 Live Births) 44 (SRS 2011) Improved from 61 in 2005 2 Maternal Mortality Ratio (number/lakh Live Births) 261 (SRS 2009) Improved from 312 in 2005 3 Total Fertility Rate (no. of births/woman) 3.6 (SRS 2011) 4 Child marriage (marriage before 18 yrs) 23 (AHS 2010) 5 Life Expectancy at Birth 6 Anaemia (All women 15-49 years) % (SRS 2011) 68.3 (NFHS 3, 2005-06) 65.5(M) & 66.2 (F) Improved from 3.9 in 2005 Improved from 46% in 2009 Improved from 61.6 (M) & 59.7(F) in 2001 7 Malnutrition (children under 3 years of age)* 58.4 (NFHS 3, 2005-06) Worsened from 63% in 1999 Worsened from 54% in 1999 8 Sex Ratio (no. of females/1000 males) 916 (Census 2011) Worsened from 921 in 2001 *Data available for under 3 children, however supplementary nutrition programme is proposed for all children up to 14 years through AWCs and Schools The challenges would be met with intensive and concerted efforts of various stakeholders.#3Health, Population and Nutrition Sector- Goals SZ S. Indicators Latest situation Target by N 2017 Target by 2022 1 Infant Mortality Rate (IMR) 44 (SRS 2011) 26 <20 (number/1000 Live Births) 2 Maternal Mortality Ratio (MMR) 261 (SRS 2009) 119 <90 (number/Lakh Live Births -LLB) 3 Total Fertility Rate (TFR) 3.6 (SRS 2011) 2.9** 2.1 (number of births/woman) 4 Malnutrition (children under 3 years) %* 58.4 (NFHS-3, 2005-07) 29 <18% 5 Anaemia (All women 15-49 years)% 68.3 (NFHS-3, 2005-07) 34 <20% 6 Life Expectancy at Birth (years) (SRS 2011) M - 65.5; F-66.2 M- 68.6 M-69.6 F-68.7 F- 70.2 7 Sex Ratio (no. of females/1000 males) 916 (Census 2011) 930 960 8 Child Marriage (marriage before 18 yrs) % 20.2 (AHS 2010) 14** <10 The targets given by MOHFW, Gol (12th Five Year Plan targets-Page-4 &16). **GoB estimates *Data available for under 3 children, however malnutrition seems to be a problem amongst school age children#4Infant Mortality Rate (IMR): Trend and Targets 70 62 61 60 61 61 60 58 56 60 52 52 48 44 50 40 36 40 33 30 28 26 30 20 10 110 0 2000 • • We are here Poor progress in 2002-2005 Better than national average in 2008-2011 Bihar caught up with National level IMR in 2011 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 MVM Goal#5Maternal Mortality Ratio (MMR): Trend and Targets 600 531 500 400 400 371 312 300 200 100 Good progress of reduction of MMR after 2005 0 1997-... 1999-... 2001-... 2004-... 2007-... We are here 2012 261 201 2013 183 165 149 133 119 2014 2015 2016 MVM Goal 2017#6Total Fertility Rate (TFR): Trend and Targets 6 5.7 Total fertility rate in Bihar is one and half times of All India average and is the highest 4.8 5 4 3 2 4.0 3.9 3.7 3.7 3.6 3.4 3.2 3.1 3.0 2.9 We are here Pursuing formal Education of Girls up to 10+2 will facilitate 1 Reduction of Fertility Rate by 70% MVM Goal 0 1980 1990 NFHS-I NFHS-II NFHS-III 2009-10 2011-12 2013 2014 (92-93) (98-99) (05-06) 2015 2016 2017#770 60 60 50 40 Malnutrition: Trend and Targets 58.4 54.3 49 We are here Child Undernutrition Index HIGHEST in Bihar Malnutrition associated with 54% of Under Five Year Children Deaths 42 37 33 29 30 20 Data available for under 3 children, however malnutrition seems to be a problem amongst school age children 10 National Undernutrition Rate reduced by 2.3 % whereas in Bihar it increased by 4.1% between NFHS II and NFHS III a gap of 7 years 0 NFHS -2 NFHS-3 2013 2014 2015 2016 2017 (1998-99) (2005-06)#880.0 70.0 63.4 60.0 Anaemia: Trend and Targets 68.3 50.0 We are here 40.0 30.0 57 49 43 38 34 20.0 10.0 National and Bihar Anaemia rate has increased by 4% between NFHS II and NFHS III a gap of 7 years MVM Goal 0.0 NFHS -2 NFHS -3 2013 (1998-99) (2005-06) 2014 2015 2016 2017#91100 1050 1061 1000 950 900 850 800 1051 Sex Ratio: Trend and Targets Sex ratio in the urban areas of Bihar has declined sharply to only 916 females against 1000 males as per the 2011 census 1020 1002 1000 1005 995 957 948 We are here 940 930 921 916 907 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011 2017 2022#10Child Marriage: Trend and Targets 50 45 45.9 40 35 30 25 20 20 15 10 5 We are here 20.2 18.0 16.0 14.0 MVM Goal 0 DLHS-III (2007-08) AHS (2010-11) 2013-14 2015-16 2017-18#11Life Expectancy at Birth: Trend and Targets 72.0 70.0 68.0 70.2 68.7 69.6 66.2 68.6 66.0 65.5 64.0 62.0 62.0 60.0 60.1 58.0 56.0 54.0 2001-05 2006-10 2011-15 2016-20 -Male 62.0 65.5 68.6 69.6 -Female 60.1 66.2 68.7 70.2#12Expand Human Resources in Health (Recommendations of High Level Expert Group Report- As per WHO norms: Universal Health Coverage (UHC) 1. Human Resources (HR): 100 Medical Officers; 300 nurses (ANM+GNMS); 230 health workers per 100,000 population. As of now, Bihar has only 4 Medical Officers; 18 Nurses and 22 health workers per lakh population. 2. Hospital Beds: 100 beds per 1 lakh population. As of now, Bihar has 26,896 beds (as against 1,00,000 beds) The shortage of manpower in the Department is enormous, but the Department systematically envisages the gaps and has planned to bridge them in phased manner. Steps in this direction would include ○ Opening new medical colleges, both govt. and private • Increasing the number of seats of existing colleges- ○ Upgrading district hospitals into teaching hospitals ○ Expanding PG seats to provide faculty and also specialty care ○ Introduce Public Health Cadre first line supervisors#13The Department Social Welfare (ICDS) PHED Education (Primary & Secondary) Panchayati Raj Dept. Intersectoral Convergence Areas needing convergence Growth monitoring, Nutrition & IFA supplementation for pregnant & nursing women and adolescents and promoting Positive Deviance Approach (PDA) for convincing families for better feeding and care. Universalization of ICDS services Capacity Building of AWWs on IMNCI Programme Promotion of Kitchen Gardens through MNREGA with involvement of PRI members Safe water supply and household toilet building IFA weekly supplementation, hand wash and other hygiene practices, use of toilets. Improve the nutritional value of Mid-Day-Meal for ALL schools Messages of "Dus Ka Dum, Shwathy Rahenge Hum" in school and college books IEC/Communication with PRI and Community mobilization Orientation of PRI Members on Newborn Care VHSC- provide mobility support to transport the sick newborns Support to VHSND Operationalization Monitoring & Supervision of ANM/AWW activities through their standing committees. Strengthening PDS and food security#14Sr. No. A 2 3 10 5 6 Major Heads ONGOING INTERVENTIONS Infrastructure (Upgradation of PHC to CHC; Establishment of SNCU/NBSU; L1 centers etc) Human Resources (Medical Officers, Specialist, ANMs, Staff Nurses, Paramedics etc) Drugs and Consumables (SNCU/ICU/Emergency/FP etc) Equipments & Diagnostics (MH,CH,FP,Training etc) Capacity Development (Maternal health, Child Health, PNDT,FP,ARSH, WIFS Patient Transport Services Total Cost (in Cores) 20,156 1,412 653 21 63 etc) 1,551 23,856 (Ambulances-102/108) SUB TOTAL NEWER INTERVENTION B 1 2 = The Bihar Model of Preventive Health Care (Dus Ka Dum (DKD) Swasth Rahengey Hum) Common Minimum Programme-Innovative Solutions (DPF) 10 61 3 Mukhya Mantri Kanya Suraksha Yojna (Bihar) Proposed revision... 9,600 4 10 5 Nutrition Care (Nanny's at AWC) Promote Directly Observed Consumption (DOC) of IFA supplementation in Schools: SUB TOTAL GRAND TOTAL 36 1 9,707 33,563#15Policy considerations: • Integrated Health Policy including mainstreaming of AYUSH • State Health Human Resource policy • State nutrition policy • State Nutrition Mission Policy to encourage private sector participation in health sector#16Thank You हमारा संकल्प हर बच्चे की स्वास्थ्य सुरक्षा राज्य स्वास्थ्य समिति, बिहार K