Child health situation in the state has shown improving trend with enhanced focus and intervention through flagship programmes like National Rural Health Mission and National Aids Control Programme - III and works towards contributing for overall accelerated achievement of MDG 4, 5 and 6 in the state.
Some of the important factors and indicators of child health have been explored further to provide an overall picture of status of children’s health in the state. Indicators like crude birth rate, crude death rate, life expectancy of people at birth, child immunisation, maternal health care and infrastructure in health care system; are appropriately analysed for the revelation of the health status of people. It is observed that death rate for people in Orissa is much higher and life expectancy is lower than at the national level. The Crude Death Rate (CDR) in Orissa is 8.3, whereas this is 7.3 for India. The underlying causes of child mortality are diarrhoea, gastroenteritis, aneamia and jaundice which together accounted for 35.4% of total child’s death. As regards to immunization, barely 62.4% (NFHS III, 2005-06) of children are fully immunized. Though institutional delivery is an ideal indicator of maternal and child health, still the state has not shown significant progress in this respect. For Orissa, institutional delivery is 44.3% and it is even worse in the district of Malkangiri (7.1%), Raygada (11.9), Gajapati (13.0%), Keonjhar (15.5%), Nuapada (16.6%), Koraput (16.9%) and Nawrangpur (19.9%). (NFHS-III)
Quality of health care in the primary tier of the health system shall have important bearing on the achievement and credibility of the system. In the health sector there is a necessity for ensuring the services of doctors and other paramedical staffs in every health care system and more particularly in the interior and tribal pockets. There has hardly been any improvement in terms of system load of government hospitals between 2005-06 and 2009-10. There are 12 doctors per one lakh population and less than 4 beds per 10,000 population. However, the proportion of patients in total population of state declined from 70.8 percent in 2005-06 to 65.3 percent in 2009-10. By the end of 2009-10, 1,880 medical institutions, comprising 142 hospitals, 377 community health centers, 1162, primary health centers and 199 Mobile health units were functional in public sector. In the state by 2009-10, there were about 25 medical institutions per lakh of population and one medical institution per 16 Sq. Kms of area. The bed Population ratio stood at 1:1798. As per the survey report of International Institute of Population Sciences, Mumbai, only 3.2% of PHCs in the State have proper infrastructure. As on 30th April’2004, 9.3% total sanctioned post of doctors and 7.2% of staff nurse were lying vacant.
Table: Status of children and maternal health in Orissa (Health Indicators)
|Population(Million in 2011)||41.9||1210|
|SC and ST population %||38.5||24.4|
|Infant Mortality rate total||65||50|
|Neo Natal Mortality Rate urban||16|
|Neo Natal Mortality Rate rural||23|
|Under 5 Mortality rate rural||87|
|Under 5 Mortality rate urban||54|
|Crude Birth Rate total||21||22.5|
|Crude Death Rate total||8.8||7.3|
|Natural Growth Rate total||12.2||15.2|
|Mothers with 3 ANC for last birth||60.9||50.7|
|Children fully immunized up to 1 yr||71||58.8|
|Children with BCG coverage||96.2||87.4|
|Children with measles coverage||85.8||70.9|
|Under weight U-3 children||44.0||45.9|
|Exclusive breast feeding||50.2||46.3|
|Life expectancy at birth||63.5|
Annual Health Survey report for Orissa 2011, places IMR at 62 which a very small progress from the level 65 per 1000 live births as per the (Sample Registration System 2009) third highest in country after Uttar Pradesh and Madhya Pradesh) and under 5 mortality rate of 81 / 1000 live births (Annual Health Survey 2011) is the second highest after Madhya Pradesh. The state launched IMR mission in 2001 and had been successful in reducing the IMR by 22 points as of 2008 but after that the data indicates a slowdown. The complete immunization coverage in state has risen from 53.5% to 62.4% (DHLS 2 & 3).The Neonatal mortality rate contributes to 66% of IMR and 50% of under 5 mortality rates in state. The state has jointly developed an eight point comprehensive child health plan for NRHM 2007-2012 to reduce IMRe and u-5MR.
Orissa currently with MMR of 275/100000 live births (ASH 2011) is among states with fairly high MMR. With complete ANC rate at 61.8% (NFHS 3) and institutional delivery rate at 44% (DLHS 3), the challenge towards saving lives of mothers lies in a) ensuring access to quality skilled birth attendance services at domiciliary level, b) ensuring operational 24 hrs basic emergency obstetric and neonatal care for increased institutional deliveries c) strengthening of first referral unit services and d) ensuring retention of mothers delivering at the institutions for at least 48 hrs. The rise in institutional deliveries to 44.3% establishes improved health seeking behaviour of families for safe deliveries. The challenge, however, lies in strengthening infrastructures supported by skilled human resource to provide services. It is targeted to reduce the MMR to 119 in Orissa by the end of the 11th plan period.
The incidence of malaria, TB, and other communicable diseases like HIV/AIDS etc is found to be high in Orissa. The state has to control these communicable diseases for achieving MDG 6. The state has been implementing vertical programmes on Malaria control and HIV/AIDS for long and has demonstrated significant progress in malaria control. The number of confirmed malaria cases per 100 population has come down from 12.7 in 2002 to 9.1 in 2008 in the state, but the number varies widely across districts. Fatal cases due to malaria are higher among females than males and among children than adults.
In the field of HIV/AIDS, the state in line with NACP (I-III) has moved from awareness generation programmes to service delivery programmes leading to establishment and operationalization of expanded ICTC services in state since April 2006. A total of 184 Integrated counseling and testing services have been set up in the state with 187 counselors and 136 Lab Technicians.
Statistical profile of Child Health: Orissa