Reproductive health, and child health and nutrition in India: meeting the challenge.
Reproductive health, and child health and nutrition in India: meeting the challenge.
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DOI：
10.1016/s0140-6736(10)61492-4
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发表时间：
2011-01-22
期刊：
影响因子：
168.9
通讯作者：
Kirkwood, Betty
中科院分区：
文献类型：
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作者：
Paul, Vinod Kumar;Sachdev, Harshpal Singh;Mavalankar, Dileep;Ramachandran, Prema;Sankar, Mari Jeeva;Bhandari, Nita;Sreenivas, Vishnubhatla;Sundararaman, Thiagarajan;Govil, Dipti;Osrin, David;Kirkwood, Betty
拥有10多亿人口的印度在改善公民健康和营养方面面临许多挑战。生育率、孕产妇、婴儿和儿童死亡率稳步下降，严重营养不良现象普遍存在，但步伐缓慢，没有达到国家和千年发展目标的具体目标。可能的解释包括社会不平等、国家之间和国家内部卫生系统的差异，以及城市化和人口转型的后果。2005年，印度启动了国家农村卫生使命，这是一项加强卫生系统的非同寻常的努力。然而，优先干预措施的覆盖面仍然不够，现有干预措施的内容和质量也不够理想。对避孕的大量需求仍未得到满足，青春期怀孕很常见，安全堕胎的机会不足。机构分娩数量的增加并没有与分娩和新生儿护理质量的改善相匹配。婴幼儿得不到所需的卫生保健；新生儿疾病、腹泻和肺炎获得有效治疗的机会几乎没有改善；营养方案的覆盖面不足。在规划、筹资、人力资源、基础设施、供应系统、治理、信息和监测方面的不足表明，缺乏运作良好的卫生系统。我们通过有效的管理、各区的分散规划、对影响卫生保健需求的合理的筹资办法、提高认识和改变健康和营养行为的运动以及根据证据修订儿童营养方案，为卫生系统的变革提供了一个案例。这一议程需要最高级别的政治承诺和人民运动的发展。
India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people’s movement.