Integrated interventions for child survival--a case study.

Integrated interventions for child survival as carried out in community health project of SEWA-Rural, a voluntary organisation working in tribal area of Gujarat, were discussed. They were introduced in phased manner over a period of ten years. It throws considerable light on field problems and how they can be overcome. The interventions mainly related to development of local manpower, appropriate technology like delivery pack and pictorial cards, functional referral support and linkages with other agencies, particularly with government. The latter is quite unprecedented in which the state government handed over entire PHC to a voluntary organisation. Utilisation of majority of Maternal & Child Health services has reached up to the target to be achieved by 2000 A.D. There is near-eradications of measles mortality, newborn tetanus and dramatic fall in the prevalence of vitamin A deficiency, complication of childhood tuberculosis and dehydration death. The childhood & infant mortalities have reduced to less than half, but after an initial fall there was very little further improvement in perinatal and neonatal mortality. There is an immediate need to strengthen the existing facilities of neonatal and perinatal care at all level. Those who conduct most of the deliveries in rural area, i.e. TBA's and nurses at home and in health center required appropriate training to improve their skill and knowledge. There is a need to design safe, simple, cheap but efficient technology to diagnose and manage low birth weight babies and birth asphyxia at community level.