In India, an estimated 26 million of children are born every year. As per Census 2011 [1], the share of children (0-6 years) accounts 13% of the total population in the Country. The child health programme under the National Health Mission (NHM) comprehensively integrates interventions that improve child survival and addresses factors contributing to infant and under-five mortality. It is now well recognised that child survival cannot be addressed in isolation as it is intricately linked to the health of the mother, which is further determined by her health and development as an adolescent. Therefore, the concept of Continuum of Care, that emphasises on care during critical life stages in order to improve child survival, is being followed under the national programme. Another dimension of this approach is to ensure that critical services are made available at home, through community outreach and through health facilities at various levels (primary, first referral units, tertiary health care facilities). The newborn and child health are the two key pillars of the Reproductive, maternal, newborn, child and adolescent health (RMNCH+A) [2] strategic approach, 2013. The Child Health programme under the Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy of the National Health Mission (NHM) comprehensively integrates interventions that improve child health and nutrition status and addresses factors contributing to neonatal, infant, under-five mortality and malnutrition.

According to the new National Health Policy [3] laid down in 2017, the target is to achieve Infant Mortality Rate to 28 per 1000 live births by 2019, Neonatal Mortality Rate to 16 per 1000 live births by 2025 and Under 5 Mortality Rate to 23 per 1000 live births by 2025.

While the data from the National Family Household Survey [4] 2015-16 and Sample Registration System [5] last carried out in 2018 reveal that Infant Mortality Rate, Neonatal Mortality Rate and Under 5 Mortality Rate achieved so far are as 32, 23 and 36 per 1000 live births respectively. Sustainable development goal number 3.2 aims to end preventable deaths of newborn and children under 5 years of age by reducing neonatal mortality to at least 12 per 1000 live births and under 5 mortality to at least as low as 25 per 1000 live births by the year 2030 [6].

To address the issues of higher neonatal and early neonatal mortality, facility based newborn care services at health facilities have been emphasized. Setting up of facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust area under NHM. States have been asked to set up at least one SNCU in each district [7]. SNCU is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for round the clock services. NBSUs are established at community health centres or First Referral Units (FRUs). These are 4 bedded units with trained doctors and nurses for   stabilization   of   sick  newborns.  These  are  1  bedded facility attached to the labour room and Operation Theatre (OT) for provision of essential newborn care. NBCC at each facility where deliveries are taking place should be established.

Janani Shishu Suraksha Karyakram (JSSK) [8] was launched on 1st June 2011 and has provision for both pregnant women and sick new born till 1 year after birth are free and zero expense treatment, free drugs and consumables, free diagnostics and diet, free provision of blood, free transport from home to health institutions, free transport between facilities in case of referral, drop back from institutions to home and exemption from all kinds of user charges. The initiative would further promote institutional delivery, eliminate out of pocket expenses which act as a barrier to seeking institutional care for mothers and sick new borns and facilitate prompt referral through free transport.

Another scheme was launched to incentivize ASHA for providing Home Based Newborn Care [9]. The Accredited Social Health Activist (ASHA) will make visits to all newborns according to specified schedule up to 42 days of life. The proposed incentive is Rs. 50 per home visit of around one hour duration, amounting to a total of Rs. 250 for five visits. This would be paid at one time after 45 days of delivery, subject to the recording of weight of the newborn in MCP card, ensuring BCG, 1st dose of OPV and DPT vaccination, both the mother and the newborn are safe till 42 days of the delivery and registration of birth has been done. In addition, under Home Based Care of Young Child (HBYC) [10] programme, the additional five home visits will be carried out by ASHA with support from Anganwadi workers. ASHA will provide home visits on 3rd, 6th, 9th, 12th and 15th months to promote early initiation of breast feeding, exclusive breast feeding till 6 months and continued breast feeding till 2nd year of life along with adequate complementary feeding, prevention of childhood Pneumonia and Diarrhoea and to ensure age-appropriate immunization and early childhood development. The quarterly home visits schedule for low-birth-weight babies, SNCU and NRC discharges will now be harmonized with the new HBYC schedule. ASHAs will be provided incentive of Rs. 250 for completion of 5 home visits under HBYC for each young child (Rs. 50 per visit) as per the recommended schedule and additional commodities namely ORS packet and Iron Folic Acid syrup will be provided in the kit.

Navjaat Shishu Suraksha Karyakram (NSSK) [11] is a programme aimed to train health personnel in basic newborn care and resuscitation, has been launched to address care at birth issues i.e. prevention of hypothermia, prevention of infection, early initiation of breast feeding and basic newborn resuscitation. Newborn care and resuscitation are an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this new initiative is to have a trained health personal in basic newborn care and resuscitation at every delivery point. The training is for 2 days and is expected to reduce neonatal mortality significantly in the country. 

Severe Acute Malnutrition is an important contributing factor for most deaths amongst children suffering from common childhood illness, such as diarrhoea and pneumonia. Deaths amongst SAM children are preventable, provided timely and appropriate actions are taken. Nutritional Rehabilitation Centres (NRCs) are being set up in the health facilities for inpatient management of severely malnourished children, with counselling of mothers for proper feeding and once they are on the road to recovery, they are sent back home with regular follow up [12].

Anemia is a silent epidemic impacting our physical growth, mental and work capacity and lives of future generations. All population groups in India are affected by anemia and, hence, intensified efforts are needed to tackle this problem. Six key interventions have been identified viz prophylactic iron folic acid supplementation, periodic deworming of children, adolescents, women of reproductive age and pregnant women, intensified year-round behavior change communication campaign including ensuring delayed cord clamping, testing of anemia using digital methods and point of care treatment, mandatory provision of iron and folic acid fortified foods in public health programmes and addressing non-nutritional causes of anemia in endemic pockets, with special focus on malaria. Key performance indicators are Percentage of children 6-59 months who received at least 8 doses of IFA syrup, Percentage of school children 5-9 years who received at least 4 Pink coloured IFA tablets, Percentage of school-going adolescents 10-19 years (girls and boys), eligible under WIFS programme, who received at least 4 Blue coloured IFA tablet, Percentage of women of reproductive age 20-24 years, eligible under Mission Parivar Vikas, who received at least 4 Red coloured IFA tablet (NEW) Percentage of eligible pregnant women who received at least 180 IFA tablets during antenatal contact point and Percentage of states/districts with available stocks of IFA for all age groups [13].

1. "Census Data 2011." Census of India 2011, https://censusindia.gov.in/2011-common / censusdata 2011.html.

2. Taneja, G., et al. "India's RMNCH+A Strategy: Approach, Learnings and Limitations." BMJ Global Health, vol. 4, no. 3, 2019, e001162, DOI: 10.1136/bmjgh-2018-001162.

3. "National Health Policy 2017." National Health Portal of India, https:// www. nhp. gov. in/ nhpfiles/ national_ health_policy_2017.pdf.

4. "NFHS-4 Report: India." National Family Health Survey, http://rchiips.org/nfhs/NFHS-4Reports/India.pdf.

5. "Sample Registration System Reports 2018." Census of India Vital Statistics, https://censusindia.gov.in/vital_statistics/SRS_Reports_2018.html

6. Kroll, C., et al. "Sustainable Development Goals (SDGs): Are We Successful in Turning Trade-Offs into Synergies?" Palgrave Communications, vol. 5, 2019, p. 140, DOI: 10.1057/s41599-019-0335-5.

7. Neogi, S., et al. "Inpatient Care of Small and Sick Newborns in Healthcare Facilities." Journal of Perinatology, vol. 36, 2016, pp. S18–S23, DOI: 10.1038/jp.2016.186.

8. Chaudhary, S., et al. "Evaluation of Janani Shishu Suraksha Karyakram Scheme and Out-of-Pocket Expenditure in a Rural Area of Northern India." Journal of Family Medicine and Primary Care, vol. 6, no. 3, 2017, pp. 477–481, DOI: 10.4103/2249-4863.222010.

9. Bang, A., Bang, R., and Reddy, H. "Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003)." Journal of Perinatology, vol. 25, 2005, pp. S108–S122, DOI: 10.1038/sj.jp.7211278.

10. Landers, S., et al. "The Future of Home Health Care: A Strategic Framework for Optimizing Value." Home Health Care Management and Practice, vol. 28, no. 4, 2016, pp. 262–278, DOI: 10.1177/1084822316666368.

11. Bansal, S.C., et al. "Current Neonatal Resuscitation Practices among Paediatricians in Gujarat, India." International Journal of Pediatrics, 2014, article 676374, DOI: 10.1155/2014/676374.

12. Tandon, M., et al. "Performance of nutrition rehabilitation centers: A case study from Chhattisgarh, India." International Journal of Preventive Medicine, vol. 10, 2019, article 66, DOI: 10.4103/ijpvm.IJPVM_194_17.

13. Kishore, S., et al. "A Study to Assess Prevalence of Anaemia among Beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand." Journal of Family Medicine and Primary Care, vol. 9, no. 3, 2020, pp. 1691–1694, DOI: 10.4103/jfmpc.jfmpc_941_19