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What is four minutes in the course of a day? Trivial one would think. But that is the tiny sliver of time it takes for India to lose one child to pneumonia.  The country is on top of the list of nations across the world, both in terms of disease burden and the largest number of pneumonia deaths. This is a public health emergency in every respect, an unacceptable fact in today’s highly developed world and society. What is baffling and even more unacceptable is the low priority that is given to the infection – for pneumonia is the single largest killer of children worldwide. Not surprisingly, pneumonia is the ‘forgotten killer’ of children according to the World Health Organisation (WHO).

This is ironical, because there is enough and more knowledge about protection from and treatment of pneumonia across the world – whether it is proven cost-effective interventions, policy and programme responses, ways to convince communities to keep themselves protected from the infection and many other important aspects of managing the illness. Despite all that, in India, 30 million episodes of Acute Respiratory Infections (ARI)/pneumonia are reported every year, and pneumonia is the leading infectious cause of death among children.  Doubtless, it is vital to foster and catalyse, or even build, the drive and leadership among Government, policy makers, international agencies and all other relevant stakeholders so that the overall response to tackling pneumonia can be accelerated on all fronts, both in India and across the world. This approach would be critical if the Sustainable Development Goal 3, of ending all preventable child deaths by 2030, is to be achieved.

With a vision to end preventable under-five deaths due to pneumonia in India by 2030, Save the Children, India (SC India/ Bal Raksha Bharat) is committed to working in alignment with the Indian government, key stakeholders and donors to address all aspects of pneumonia morbidity and mortality in children. Through the publication of a major report titled Fighting for Breath: A Call to Action on Childhood Pneumonia in 2017, SCI has declared a massive global effort against pneumonia, aiming to save a million lives in the next five years. In order to effectively mount such efforts in India, there was a felt need to generate current and up-to-date evidence on the enablers and barriers in the response that is underway and required to prevent childhood pneumonia deaths in India.

This report encapsulates results from a comprehensive situational analysis, including an in-depth assessment of high burden states (Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand, Rajasthan), that was carried out in order to systematically generate essential and current evidence related to burden of morbidity and mortality in study states and; enablers and barriers for reducing preventable pneumonia deaths in India through primary and secondary research. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD)  framework developed for pneumonia management sets out various indicators that are considered to have impact on pneumonia care under three heads: Prevent, Protect and Treat. This study also tried to assess the impact of various indicators under these heads.  Based on the evidences, the study suggests policy recommendations and operational researches vital for tacking pneumonia in the country.