Why Should 5,000 Children Die in India Every Day? Major Causes of Death and Managerial Challenges

Globally, more than 10 million children, under five years of age, almost all in poor countries, die every year (20 children per minute), mostly from preventable causes. The major causes of child death include neonatal disorders (death within 28 days of birth), diarrhoea, pneumonia, and measles with malnutrition being a major contributing factor for childhood illnesses. India alone accounts for almost 5,000 deaths of under-five years children (U5) every day. In 1975, the Integrated Child Development Scheme (ICDS) was launched in the country to provide integrated health and nutrition services focusing upon the holistic development of children at the village level. Yet by 2005, 50 per cent of the children in India were still malnourished. India's neonatal mortality, which accounts for almost 50 per cent of the U5 deaths, is one of the highest in the world. India launched the Universal Immunization Programme (UIP) in 1985. Yet full immunization in India had reached only 43.5 per cent by 2005-06, as per the NFHS 31. This paper, besides discussing the status of mortality of children and the situation of child health services, examines the managerial challenges of the child health programmes in India. There is a need for improving the management capacity amongst health service providers, specifically the planning and implementation of child health programmes such as immunization, control of diarrhoea, and pneumonia. The analysis of the trends of the past decline shows that during 1990-2008, India achieved a decrease in infant mortality rate (IMR) at a very low annual average rate of 1.9 per cent. To achieve Millennium Development Goals (MDG) 4, between 2009— 2015, the rate of reduction of IMR needs to be increased to a very high level — at 6.74 per cent every year. This means that the government and the private sector need to improve the effectiveness and efficiency of the child health programmes substantially. Incremental improvement over “business-as-usual” will not help in achieving MDG 4. Effective and efficient management of child health programmes would require focused political and administrative attention and managerial capacity.