As per Office of
Registrar General of India SRS 2010 report, Rural Under-five mortality
rate is 66 per 1000 live births whereas urban under-five mortality rate
is 38 per 1000 live births.
The possible reasons for higher under-five mortality rate in rural areas
are lack of awareness, poor health seeking behaviour, inappropriate
child care practices and inadequate access to quality health services.
Under NRHM, higher financial resources are being provided to States and
districts with weak health indicators. Further, the following
interventions under RCH progamme under National Rural Health Mission (NRHM),
are being implemented to reduce U5 MR in rural areas:
1) Promotion of Institutional Delivery through JananiSurakshaYojana (JSY)
and JananiShishuSurakshaKaryakram (JSSK): Promoting Institutional
delivery to ensure skilled birth attendance is key to reducing both
maternal and neo-natal mortality. JSY incentivizes pregnant women to opt
for institutional delivery and provides for cash assistance. JSSK
entitles all pregnant women to absolutely free and zero expense delivery
including caesarean section operation in Government health facilities
and provides for free to and fro transport, food, drugs and diagnostics.
Similar entitlements have also been put in place for sick neonates.
2) Strengthening Facility based newborn care: Newborn care corners (NBCC)
are being set up at all health facilities where deliveries take place to
provide essential newborn care at birth to all new born babies; Special
New Born Care Units (SNCUs) at District Hospitals and New Born
Stabilization Units (NBSUs) at FRUs are being set up for the care of
sick newborn. As on date 399 SNCUs, 1542 NBSUs and 11508 NBCCs are
functional across the country.
3) Home Based Newborn Care (HBNC): Home based newborn care through ASHA
has recently been initiated to improve new born care practices at the
community level and for early detection and referral of sick new born
babies. The schedule of home visits by ASHA consists of at least 6
visits in case of institutional deliveries, on days 3, 7, 14, 21, 28 &
42nd days and one additional visit within 24 hours of delivery in case
of home deliveries. Additional visits will be made for babies who are
pre-term, low birth weight or ill.
4) Capacity building of health care providers: Various trainings are
being conducted to build and upgrade the skills of doctors, nurses and
ANMs for early diagnosis and case management of common ailments of
children and care of newborn at time of birth. These trainings include
Integrated Management of Neo-natal and Childhood Illness(IMINCI) and
NavjaatShishuSurakshtaKaryakaram (NSSK). A total of 5.5 lakh health care
workers have been trained in IMNCI in 471districts and 88,428 health
workers trained in NSSK so far.
5) Management of Malnutrition: Emphasis is being laid on reduction of
malnutrition which is an important underlying cause of child mortality.
594 Nutritional Rehabilitation Centres have been established for
management of Severe Acute Malnutrition (SAM). Iron and Folic Acid is
also provided to children for prevention of anaemia. Recently, weekly
Iron and Folic Acid is proposed to be initiated for adolescent
population. As breastfeeding reduces infant mortality, exclusive
breastfeeding for first six months and appropriate infant and young
child feeding practices are being promoted in convergence with Ministry
of Woman and Child Development.
6) Village Health and Nutrition Days (VHNDs) are also being organized
for imparting nutritional counseling to mothers and to improve child
7) Universal Immunization Program (UIP): Vaccination against seven
diseases is provided to all children under UIP. Government of India
supports the vaccine program by supply of vaccines and syringes, cold
chain equipments and provision of operational costs. UIP targets to
immunize 2.7 crore infants against seven vaccine preventable diseases
every year. 21 states with more than 80% coverage have incorporated
second dose of Measles in their immunization program. Pentavalent
vaccine has been introduced in two states of Kerala and Tamil Nadu and
proposed to be scaled up in six more states. Year 2012-13 has been
declared as ‘Year of intensification of Routine Immunization’.
8) Mother and Child Tracking System: A name based Mother and Child
Tracking System has been put in place which is web based to enable
tracking of all pregnant women and newborns so as to monitor and ensure
that complete services are provided to them. States are encouraged to
send SMS alerts to beneficiaries reminding them of the dates on which
services are due and generate beneficiary-wise due list of services with
due dates for ANMs on a weekly basis.
This information was given by Minister for Health & Family Welfare Shri
Ghulam Nabi Azad in written reply to a question in the Rajya Sabha