Lok Sabha Question No. 3410 (UNSTARRED), answered on 2015-12-18
Subject: Under Five Mortality
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SUSHMITA DEV, K. ASHOK KUMAR, J.C. DIVAKAR REDDY, JYOTIRADITYA MADHAVRAO SCINDIA, KIRIT PREMJIBHAI SOLANKI, ANURAG SINGH THAKUR, ASADUDDIN OWAISI, KIRTI VARDHAN SINGH

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3410 TO BE ANSWERED ON 18 TH DECEMBER, 2015

## UNDER FIVE MORTALITY

## 3410. KUMARI SUSHMITA DEV:

SHRI K. ASHOK KUMAR:

SHRI J.C. DIVAKAR REDDY:

SHRI JYOTIRADITYA M. SCINDIA:

DR. KIRIT P. SOLANKI:

SHRI ANURAG SINGH THAKUR:

SHRI ASADUDDIN OWAISI:

SHRI KIRTI VARDHAN SINGH:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the country is on the track toachieve the Fourth Millennium Development Goal (MDG-4) of reducingthe  under  five  mortality  rate  by  two - third, if  so,  the  details  thereof  and  if  not,  the reasons therefor;
- (b) whether the Government has taken note of the revelation made by the United Nations Children's Fund  (UNICEF)  that one  in  every  twenty  one  children  being  born in  the  country  is dying  before reaching their fifth birthday, if so, the details thereof and the reaction of the Government thereto;
- (c) whether the UNICEF has also projecte d that by 2030, India along with other five countries will account for more than half of all under five deaths, if so, the details thereof along with the corrective measures taken/being taken by the Government in this regard;
- (d)  the  details  of  the  child mortality  rate during  each  of  the  last  three  years  and  the current  year, State/UT - wise along with the programmes/schemes launched by the Government and fund sanctioned, released and utilised during the said period; and
- (e) the fresh remedial measures bein g taken by the Government in this regard?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

- (a) : India  has  made  steady  progress  in  reduction  of Under- five  mortality  Rate (U5MR) from 126/1000  live  births  in  1990  to  49/1000  live  births  in  2013  as  per  the  Sample  Registration Report (SRS) of the Registrar General of India. India may achieve MDG- 4 target, if the current trend of annual decline of 6. 6 percent , as per SRS, is su stained.
- (b ) , (c) & (e):Yes, a ccording to SRS 2013, the U5MR in India is 49/1000 live birth s.As perUN I CEF projections, if current trends of under - five mortality rate continue, by 2030 ,five countries will account for more than half of all under - five deaths -India (17 per cent), Nigeria (15 per cent), Pakistan (8 p cent), Democratic Republic of the Congo (7 per cent) and Angola (5 per cent).

Under National Health Mission, the follow ing interventions  are  being  implemented  to  reduce child mortality in the Country:

1. Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in pub health institutions to absolutely free and no expense delivery including Caesarean s ection.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport fr institution, between facilities in case of a referral and drop back home. Similar entitle been put in place for all sick infants acces sing public health institutions for treatment till o year of age.
2. Facility Based Newborn Care (FBNC) at different levels to reduce child morbidity and mort by  setting  up  of  facilities  for  care  of  sick  newborn  such  as  Special  New  Born  Care (SNCUs),  Newborn  Stabilization  Units  (NBSUs)  and  Newborn  Care  Corners  (NBCCs)  at different levels is a thrust area under NHM.
3. Home  Based  Newborn  Care  (HBNC)  through  ASHAs  to  improve  new born  practices  at  the community level and early detection and referral o f sick new born babies.
4. India Newborn Action Plan (INAP) has been launched with an aim to reduce neonatal mortal and stillbirths. Newer interventions to reduce newborn mortality - Vitamin K injection at birth, Antenatal corticosteroids for preterm labou r,K angaroo mother care and injection G entamicin to young infants in cases of suspected sepsis.
5. Intensified Diarrhoea Control Fortnight (IDCF) observed in 2014 and 2015 focusing on O and Zinc distribution for management of diarrhoea and feeding practice s.
6. Integrated  Action  Plan  for  Pneumonia  and  Diarrhoea  (IAPPD)  launched  in  four  states  w highest child mortality (UP, MP, Bihar and Rajasthan).
7. Nutritional  Rehabilitation  Centres  (NRCs)  have  been  established  for  management  of  sev acute malnutrition in children.
8. Appropriate Infant and Young Child Feeding practices are being promoted in convergence w Ministry of Wom en and Child Development.
9. Village Health and Nutrition Days (VHNDs) are organized for imparting nutritional counsel to mothers and to improve child care practices.
10. 10.A name based Mother and Child Tracking System (MCTS) has been put in place which is web based to ensure registration and trackin g of all pregnant women and new born babies so that provision of regular and complete services to them can be ensured.
11. 11.Rashtriya Bal Swasthya Karyakram (RBSK) for health screening and early intervention servi has been operationalized to provide comprehensive care to all the children in the age gro -18 years in the community. The p urpose of these services is to improve the overall quality of of children through early detection of birth defects, diseases, deficiencies, developme including disability.
12. 12.Under National Iron Plus Initiative (NIPI), through life cycle appro ach, age and dose specific IFA supplementation programme is being implemented for the prevention of anaemia among the vulnerable age groups like under - 5 children, children of 6 -10 years of age group, adolescents, pregnant & lactating women and women in r eproductive age along with treatment of anaemic children and pregnant mothers at health facilities.
13. 13.National Deworming Day was observed on 10 th February, 2015 in 11 States/UT -Assam, Bihar, Chhattisgarh, Delhi, Dadra & N gar Haveli, Haryana, Karnataka, M aharashtra, Madhya Pradesh, Rajasthan,  Tamil  Nadu  and  Tripura  targeting  children  in  the  age  group  of  1 - 19  years  (both school  enrolled  and  non - enrolled),  recognising  negative  impact  of  worm  load  in  children effecting their growth and development.
14. 14.Varioustrainings  are  being  conducted  under  NHM  to  train  doctors,  nurses  and  ANMs  fo essential newborn care, early diagnosis and case management of common ailments of childr These trainings are on Navjaat Shishu, Suraksha Karyakram (NSSK), Integrated Managemen t of Neonatal and Childhood Illnesses (IMNCI), Facility Based Newborn Care (FBNC), Infant an Young Child Feeding practices (IYCF), etc.
15. 15.Universal  Immunization  Programme  (UIP):  Vaccination  protects  children  against  many  li threatening diseases such as T uberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B Measles. Infants are thus immunized against seven vaccine preventable diseases every year Government of India supports the vaccine programme by supply of vaccines and syringes, c chain equipment and provision of operational costs.
16. 16.Mission Indradhanush has been launched to  fully immunize  children who are either unvaccinated  or  partially  vaccinated;  those  that  have  not  been  covered  during  the  rou routine immunization for various reasons.
17. (d): The State and UT wise Under -five mortality rate since 2010 till 2013 (latest available data from the Sample Registration System Reports of the Registrar General of India) are placed at Annexure

The State and UT wise funds sanctioned, released and utilized towards child health for last four years are placed at Annexure II.

Trend ofUnder - 5 Mortality Rate in India (Available only for 20 bigger States)

| States           |   2010 |   2011 |   2012 |   2013 |
|------------------|--------|--------|--------|--------|
| India            |     59 |     55 |     52 |     49 |
| Andhra Pradesh   |     48 |     45 |     43 |     41 |
| Assam            |     83 |     78 |     75 |     73 |
| Bihar            |     64 |     59 |     57 |     54 |
| Chhattisgarh     |     61 |     57 |     55 |     53 |
| Delhi            |     34 |     32 |     28 |     26 |
| Gujarat          |     56 |     52 |     48 |     45 |
| Haryana          |     55 |     51 |     48 |     45 |
| Himachal Pradesh |     49 |     46 |     43 |     41 |
| Jammu & Kashmir  |     48 |     45 |     43 |     40 |
| Jharkhand        |     59 |     54 |     50 |     48 |
| Karnataka        |     45 |     40 |     37 |     35 |
| Kerala           |     15 |     13 |     13 |     12 |
| Madhya Pradesh   |     82 |     77 |     73 |     69 |
| Maharashtra      |     33 |     28 |     28 |     26 |
| Orissa           |     78 |     72 |     68 |     66 |
| Punjab           |     43 |     38 |     34 |     31 |
| Rajasthan        |     69 |     64 |     59 |     57 |
| Tamil Nadu       |     27 |     25 |     24 |     23 |
| Uttar Pradesh    |     79 |     73 |     68 |     64 |
| West Bengal      |     37 |     38 |     38 |     35 |

Source: SRS Reports (2010 - 13)

## Statement showing of State/UTs wise SPIP Approval & Expenditure towards Child Health under RCH Flexible Pool under for F.Ys 2012 -13 to 2015 - 16

Rs. In Lakhs

| S. No   | State                | 2012- 13      | 2012- 13    | 2013- 14      | 2013- 14    | 2014- 15      | 2014- 15    | 2015- 16      | 2015- 16    |
|---------|----------------------|---------------|-------------|---------------|-------------|---------------|-------------|---------------|-------------|
| .       | State                | SPIP Approval | Expenditure | SPIP Approval | Expenditure | SPIP Approval | Expenditure | SPIP Approval | Expenditure |
| 1       | Bihar                | 7994.21       | 1,377.22    | 5,393.69      | 2,929.51    | 1,240.69      | 859.68      | 1,294.97      | 52.29       |
| 2       | Chhattisgarh         | 1403.11       | 543.47      | 1,053.40      | 612.30      | 1,170.49      | 786.29      | 1,467.72      | 396.41      |
| 3       | Himachal             | 182.79        | 153.04      | 117.62        | 729.44      | 723.84        | 1,305.31    | 420.88        | 120.96      |
| 4       | J & K                | 271.47        | 134.99      | 1,192.95      | 468.29      | 647.76        | 468.26      | 487.60        | 188.14      |
| 5       | Jharkhand            | 1040.57       | 296.56      | 1,905.04      | 883.34      | 1,851.56      | 732.90      | 1,905.23      | 310.80      |
| 6       | MP                   | 3086.54       | 2,672.08    | 4,244.62      | 3,974.20    | 3,454.66      | 3,025.57    | 3,532.79      | 1,241.78    |
| 7       | Orissa               | 1233.57       | 788.94      | 1,114.75      | 622.06      | 1,562.70      | 668.28      | 1,333.38      | 267.97      |
| 8       | Rajasthan            | 3416.94       | 808.22      | 2,187.88      | 1,114.49    | 2,440.05      | 1,554.50    | 2,273.20      | 372.17      |
| 9       | UP                   | 1516.15       | 558.10      | 1,234.83      | 445.58      | 1,790.09      | 709.79      | 2,070.88      | 172.59      |
| 10      | Uttarakhand          | 233.33        | 249.54      | 150.50        | 201.89      | 215.41        | 205.23      | 392.59        | 111.74      |
| 11      | Arunachal Pradesh    | 212.70        | 61.87       | 137.83        | 64.80       | 126.49        | 89.00       | 177.32        | 140.12      |
| 12      | Assam                | 1474.33       | 776.09      | 2,575.66      | 1,568.67    | 3,003.88      | 1,591.94    | 2,030.07      | 516.40      |
| 13      | Manipur              | 93.76         | 11.80       | 38.13         | 74.84       | 177.08        | 163.51      | 142.71        | 47.49       |
| 14      | Meghalaya            | 283.01        | 34.91       | 178.22        | 12.90       | 364.50        | 78.75       | 367.50        | 40.75       |
| 15      | Mizoram              | 62.50         | 17.34       | 140.10        | 78.16       | 86.45         | 46.67       | -             | 32.59       |
| 16      | Nagaland             | 199.34        | 63.84       | 178.90        | 46.39       | 128.97        | 18.94       | 125.28        | 14.26       |
| 17      | Sikkim               | 62.50         | 15.36       | 49.01         | 50.54       | 64.91         | 49.73       | 63.25         | 12.95       |
| 18      | Tripura              | 221.21        | 56.63       | 58.07         | 88.35       | 255.55        | 185.11      | 166.98        | 50.38       |
|         | Sub Total            | 2609.35       | 1037.84     | 3355.92       | 1984.66     | 4207.83       | 2223.65     | 3073.11       | 854.94      |
| 19      | Andhra               | 4656.98       | 866.21      | 2,144.84      | 604.91      | 1,234.37      | 676.94      | 1,127.19      | 176.32      |
| 20      | Goa                  | 43.28         | 32.46       | 45.80         | 14.69       | 69.58         | 18.09       | 36.47         | 2.31        |
| 21      | Gujarat              | 4616.99       | 2,521.96    | 2,799.58      | 1,658.45    | 2,110.41      | 1,678.12    | 1,684.89      | 750.25      |
| 22      | Haryana              | 484.79        | 180.92      | 568.26        | 560.96      | 573.59        | 465.81      | 421.40        | 84.87       |
| 23      | Karnataka            | 897.08        | 553.49      | 478.10        | 302.37      | 1,024.33      | 255.02      | 856.15        | 95.25       |
| 24      | Kerala               | 1231.82       | 1,046.48    | 401.69        | 310.24      | 198.13        | 158.07      | 264.07        | 22.33       |
| 25      | Maharashtra          | 2602.04       | 2,204.45    | 1,773.38      | 2,656.63    | 2,408.12      | 1,309.78    | 1,000.12      | 60.35       |
| 26      | Punjab               | 742.00        | 394.24      | 295.35        | 47.73       | 784.41        | 637.57      | 360.85        | 73.50       |
| 27      | Tamil Nadu           | 5946.94       | 20.15       | 561.50        | 1,062.79    | 656.00        | 4,098.09    | 1,063.99      | 603.33      |
| 28      | Telangana            | -             | -           | -             | -           | 755.59        | 118.01      | 761.41        | 69.22       |
| 29      | West Bengal          | 3593.78       | 919.29      | 1,441.89      | 1,119.11    | 3,245.09      | 2,412.71    | 2,125.84      | 1,259.84    |
| 30      | Andaman & Nicobar    | 55.45         | -           | 5.98          | -           | 29.20         | 3.74        | 13.95         | -           |
| 31      | Chandigarh           | 14.03         | 0.02        | 0.40          | 0.18        | 3.08          | 0.29        | 3.53          | 0.14        |
| 32      | Dadra & Nagar Haveli | 21.01         | 3.42        | 10.20         | 3.82        | 23.60         | 1.48        | 27.62         | 0.19        |
| 33      | Daman                | 6.60          | 0.33        | -             | -           | 0.46          | 0.32        | 2.77          | 0.25        |
| 34      | Delhi                | 409.20        | 24.40       | 86.70         | 19.12       | 152.60        |             | 97.52         | 1.47        |
| 35      | Lakshadweep          | 47.00         | -           | 4.52          | -           | 15.20         | 16.20 0.27  | 21.10         | -           |
| 36      | Puducherry           | 3.20          | 3.50        | 14.96         | 5.71        | 15.60         | 8.75        | 24.40         | 0.05        |
|         | Grand Total          | 48360.2       | 17391.32    | 32584.35      | 22332.48    | 32604.44      | 24398.72    | 28145.61      | 7289.46     |

Note:

- a) SPIP-State Programme Implementation Plan.
- b) Above statement comprises of Child Health activity under RCH Flexible Pool
- c) Above mentioned Expenditure figures are as reported by States/UTs up to 30.09.2015
- d) Above Expenditure is inclusive of previous year unspent balance