Globally, more than 10 million children under 5 years of age, die every year (20 children per minute), most from preventable causes, and almost all in poor countries. Major causes of child death include neonatal disorders (death within 28 days of birth), diarrhea, pneumonia, and measles. Malnutrition accounts for almost 35 % of childhood diseases.

India alone accounts for almost 5000 child deaths under 5 years old (U5) every day. India.s child heath indicators are poor even compared with our Asian neighbors, namely Malaysia, Sri Lanka, Thailand, Vietnam, China, Nepal and Bangladesh. Within India, the states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh account for almost 60 % of all child deaths

India.s neonatal mortality, which accounts for almost 50 % of U5 deaths, is one of the highest in the world. India launched the Universal Immunization Program in 1985, but the status of full immunization in India has reached only 43.5 % by 2005-06. India started the Integrated Child Development Scheme (ICDS) in 1975 to provide supplementary nutrition to children, but 50 % of our children are still malnourished; nearly double that of Sub-Saharan Africa. The WHO/UNICEF training program on Integrated Management of Neonatal and Childhood Illnesses, known as IMNCI, started in India a few years ago, but the progress is very slow.

What is unfortunate is the fact that most of these deaths are preventable through proven interventions: preventive interventions and/or treatment interventions, but the management of childhood illnesses is very poor.

In this working paper, we bring out the nature and magnitude of child deaths in India (Chapter 1) and then share with you in Chapters 2, 3 and 4 our observations on the management of some of national programs of the government of India such as

The Universal Immunization Program (UIP)
The Integrated Child Development Scheme (ICDS)
The Integrated Management of Neonatal and Child Illnesses (IMNCI)

In the final chapter (Chapter 5), we highlight certain managerial challenges to satisfactorily address the child mortality and morbidity in our country.