::Infant Mortality Rates Improvement::

India face problems related to Infant mortality and Maternal mortality at a large scale. India also receives highest number of deaths in many acute diseases. There are various reasons for these problems but most important among them is that in India expenditure on health in very less percentage of the GDP. While in USA it is close to 14 percent in India it is close to five percent. Among this percentage government spending of health is close to one percentage only. This puts an added burden on the public to spent from their pocket. And in a country where large section of population is poor this burden is unsustainable. In last few decades economic growth of India has been very good but resultant public spending on the health sector has not improved much. The growth of India's economy now permits this long overdue increase in public financing of health. Good health has implications for development of countryas well this has been recognized by government in recent initiatives like National Rural Health Mission (NRHM), the Rashtriya Swasthya Bima Yojana (RSBY) and a multitude of state sponsored health insurance schemes.

The social objectives of all of these schemes would need to be merged and their scope considerably expanded to create a valued and viable model of UHC in India. With this objective in mind The Government is considering to roll out a National Health Assurance Mission to reduce the hard earned money of poor population in India. A Group has been constituted for preparing a comprehensive background paper for this purpose.

Every human body is a stakeholder in the health sector of India. That is why every individual must be motivated to a lead healthy life and thereby keep the burden on the public health infrastructure to the minimum. Thankfully, we are a young nation. With 65 percent of the population under the age of 35, it should not be too difficult to make optimal use of every available Rupee. Public Health is in state list, which makes it a state subject, the Central Government can only provide a supplementing role to the efforts of the States/UTs. Under the National Rural Health Mission (NRHM) central government provide accessible, affordable and quality healthcare to the rural population. National Health Mission (NHM) was approved the central government which subsumes the National Urban Health Mission (NUHM) and the National Rural Health mission objective of national health mission are also the same to provide universal access to equitable, affordable and quality health care services to all the population.

India has registered a significant decline in Infant Mortality Rate (IMR). According to the just released SRS bulletin, IMR of India has declined by three points (8% decline), from 37 per 1000 live births in 2015 to 34 per 1000 live births in 2016, compared to two points decline last year. Not only this, India also recorded a major drop in birth cohort, which has for the first time come down to below 25 million. India has registered 90000 fewer infant deaths in 2016 as compared to 2015. The total number of estimated infant deaths have come down from 930000 (9.3 Lakhs) in 2015 to 840000 (8.4 lakhs) in 2016.

According to the SRS Bulletin the gender gap in India for child survival is reducing steadily. The gender difference between female and male IMR has now reduced to <10%, giving a major boost to the 'Beti Bachao Beti Padhao' scheme of the Government.

The results signify that the strategic approach of the Ministry has started yielding dividends and the efforts of focusing on low performing States is paying off. Among the EAG States and Assam, all States except Uttarakhand have reported decline in IMR in comparison to 2015. The decline is reported as 4 points in Bihar, 3 points in Assam, Madhya Pradesh, Uttar Pradesh and Jharkhand and two points decline in Chhattisgarh, Odisha and Rajasthan.

These remarkable achievements in merely one year is also the result of a countrywide efforts to increase the health service coverage through various initiatives of the Government that includes strengthening of service delivery; quality assurance; RMNCH+A; human resources, community processes; information and knowledge; drugs and diagnostics, and supply chain management, etc.

India has avoided about 1 million (10 lakh) deaths of children under age five since 2005, owing to the significant reductions in mortality from pneumonia, diarrhoea, neonatal infections and birth asphyxia/trauma, measles and tetanus, according to study published in the latest issue of The Lancet.The 'India's Million Death Study', implemented by the Registrar General of India,is the first study to directly quantify changes in cause-specific child deaths in India, nationally and sub-nationally, from 2000-15 among randomly selected homes.

The study further illustrates that the conditions prioritized under the National Health Mission had the greatest declines. Pneumonia and diarrhea mortality fell by over 60% (most of the decline due to effective treatment), mortality from birth-related breathing and trauma during delivery fell by 66% (most of the decline due to more births occurring in hospital), and measles and tetanus mortality fell by 90% (mostly due to special immunization campaigns against each). The study states that mortality rate (per 1000 live births) fell in neonates from 45 in 2000 to 27 in 2015 (3.3% annual decline) and 1-59 month mortality rate fell from 45.2 in 2000 to 19.6 in 2015 (5.4% annual decline). Further, amongst 1-59 months, pneumonia fell by 63%, diarrhoea fell by 66% and measles fell by more than 90%. These declines were greater in girls, indicating that India has, remarkably, equal numbers of girls and boys dying, a significant improvement from just a few years ago.Pneumonia and diarrhoea mortality rates for 1-59 months declined substantially between 2010 and 2015 at an average of 8-10 % annual decline nationally and more so in the rural areas and poorer states.

The Million Death Study builds on the SRS by directly monitoring the causes of death in over 1.3 million (13 lakh) homes. Since 2001, about 900 staff interviewed about 100,000 (1 lakh) living members in all homes who had a child die (about 53,000 deaths in the first month of life and 42,000 at 1-59 months)every six months and completed a simple two-page form with a local language half-page narrative describing the deceased's symptoms and treatments. The records have been digitized and each one uniformly coded for cause of death independently by two of about 400 trained physicians, using World Health Organization approved procedures. This is a direct study based on face-to-face interviews with families, and is not based on modeling or projections from small samples.

The results signify that the strategic approach of the Health Ministry has started yielding dividends and the efforts of focusing on low performing States is paying off.

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