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Turning the Gaze from Survive to Thrive for Children in India: Learnings from Two Case Studies

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Abstract

Despite significant efforts and progress made in newborn care programs in India, implementation gaps persist across the continuum of care. The present case studies of two districts in Himachal Pradesh revealed that pathways of care were often fragmented with inconsistent linkages between facility and community due to poor documentation, lack of tiered referral, health system weaknesses, low utilization of primary level institutions, and inadequate post-natal home visits by Accredited Social Health Activists (ASHAs). Involvement of healthcare providers (HCPs) and frontline health workers (FHWs) was low and uneven in generating awareness across the districts with limited participation in supporting care in the community. Ensuring functionality of health centers and first-level care facilities; strengthening referral systems; adequate/trained human resources; strengthening routine health management systems, discharge processes and community-based care with adequate integration with facilities are necessary in closing access gaps.

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Acknowledgements

The authors would like to acknowledge the inputs from Dr. Chandrakant Lahariya and the technical team including Dr. Shruti Verma of the Foundation for People-centric Health Systems, New Delhi and external collaborators Dr. Rodney Vaz on the earlier version of this manuscript. The authors extend their sincerest gratitude to Late Dr. M K Bhan and Dr. VK Paul (formerly at Department of Pediatrics, AIIMS, Delhi), under whose guidance the study described was conceptualized. The authors are indebted to the health care professionals and caregivers who participated in the study and acknowledge the efforts of NHM (Himachal Pradesh), hospital management team, field workers, and the entire research team (Monal Nagrath, Ipsha Chaand, Sukesh Trikha, Kashika Sharma, Medhavi Manish, Akhilesh Bakshi, Minashree Horo) that made this study possible in Himachal Pradesh.

Funding

The primary study was jointly supported by Knowledge Integration and Translational Platform (KnIT) (supported by DBT-BMGF-BIRAC-Wellcome) and Gates Ventures. Project reference numbers: BIRAC/PMU/2016/KnIT/001 (PRIV010) and bgC3-Research Services 2019 (PRIV025).

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Authors and Affiliations

  1. Global Access Research, International AIDS Vaccine Initiative (IAVI), New Delhi, India

    Jessy Joseph & Ruchita Jalal

  2. Department of Pediatrics, Indira Gandhi Medical College, Shimla, India

    Mangla Sood

  3. (Former) Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi, India

    Harish Chellani

  4. (Former) Department of Biostatistics, All India Institute of Medical Science (AIIMS), New Delhi, India

    RM Pandey

  5. International AIDS Vaccine Initiative (IAVI), New Delhi, India

    Rajat Goyal

  6. (Former) Department of Neonatology, Maulana Azad Medical College, New Delhi, India

    Siddarth Ramji

  7. Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, Room No 204, New Delhi, India

    Rajib Dasgupta

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  1. Jessy Joseph
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  2. Ruchita Jalal
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  3. Mangla Sood
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  4. Harish Chellani
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  6. Rajat Goyal
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  7. Siddarth Ramji
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  8. Rajib Dasgupta
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Contributions

RDG, JJ were involved in conceptualization of the manuscript based on the insights generated from the primary study conducted in the state of Himachal Pradesh; JJ and RJ drafted the manuscript with technical inputs from RDG, HC and MS in finalizing the manuscript; RDG, SR, HC, RG, RMP, MS, and JJ were involved in the conduct of the primary study under the overall guidance of late Dr. M K Bhan. All the authors have reviewed and approved the final version of the manuscript. RDG will act as guarantor for this manuscript.

Corresponding author

Correspondence to Rajib Dasgupta.

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Ethical Approval

The ethical approval for the primary study was obtained from the Institutional Ethics Committee of Maulana Azad Medical College, New Delhi (F.1/IEC/MAMC/(62/02/2018/No 268 dated 30/3/18)).

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None.

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Joseph, J., Jalal, R., Sood, M. et al. Turning the Gaze from Survive to Thrive for Children in India: Learnings from Two Case Studies. Indian J Pediatr 90 (Suppl 1), 71–76 (2023). https://doi.org/10.1007/s12098-023-04712-8

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  • DOI: https://doi.org/10.1007/s12098-023-04712-8

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