Welcome changes

The latest annual health survey shows that two key indicators of public health and welfare - maternal and child mortality rates - have shown welcome changes even in economically and socially backward states. 

But the improvement is not as much as needed and targeted, and is uneven and inconsistent. According to the data released by the Registrar General of India, the maternal mortality rate declined by 16 per cent from 212 deaths per 1,00,000 births to 178 during the period 2007-08 to 2011-12. Infant mortality rate also declined, though not to the extent of the maternal mortality rate, from 44 deaths per 1,000 in 2011 to 42 in 2012. Nine states, in the north and east, which are the traditional laggards, have presented a better performance. 

The figures show that the country as a whole will certainly miss the millennium development goal (MSG) of 103 maternal casualties per one lakh  births  and 28 deaths per 1,000 births of children, set by the UN for the year 2015. Though some states like Kerala and Tamil Nadu have already surpassed the MDGs and other well-performing states have maintained their pace of performance, it is felt that the UN goals may be achieved at the national level only in 2025. This is disappointing because even countries with less resources, like Nepal and Bangladesh, have outperformed India. The number of deliveries in hospitals and sex ratio at birth and other important parameters have also shown improvement but the overall picture has to improve further.

One finding is that the indicators started looking up after the National Rural Health Mission (NRHM) was launched. The maximum decline in the maternal and child mortality rates occurred in the last 10 years which also coincided with the NRHM. But the NHRM, which has a budget of over Rs 20,000 crore, is scam-ridden and poorly implemented in most states. Uttar Pradesh, which has seen the worst scandal in its implementation, tops the country in child mortality rate at 68 per thousand births. More effective implementation of the mission with decentralisation of its working to the district level can produce better results. Even when some states showed improved performance, many districts remained where they were. The urban-rural divide in performance is also glaring. Factors like education of women and nutrition are also important but a more efficient implementation of the NRHM can speed up progress.