Public health gets focused attention

The government’s plan to give focused attention to 184 districts in the country in the delivery of reproductive and child healthcare can help improve the country’s overall performance in this crucial area of public health. These districts have been selected for the initiative because they have been the worst performers with respect to maternal and infant mortality rates. The announcement was made by Prime Minister Narendra Modi at the Call to Action summit in Delhi of countries that account for most maternal and infant deaths. The aim of the programme is to stop such deaths by 2030. The plan might seem too long-term. But it may be considered as only a realistic time target in view of the scale of infrastructure and investment needed to achieve the goal. Longer-term plans have failed to achieve their targets in the past. India will miss the Millennium Development Goals, set two decades ago, on infant, maternal and under-five mortality rates, though it has produced substantive results.

The special drive in 184 districts will be all the more challenging because they are also the most socially and economically backward districts. They include all tribal and underdeveloped districts in the country. It is stated that a health centre will be available within 30 minutes’ walk for any person. The existing norms for setting up such centres will be relaxed. This is important because death rates in India increase with the distance patients have to travel to the nearest health centre. The help of the private sector may also be sought but the initiative may have to be presented as a social responsibility project rather than as a profitable venture. A major challenge will be to man these centres with personnel who can provide basic medical care. 

Public health needs in any area cannot be seen in isolation from issues of development, education and similar factors. So, the special drive in the 184 districts should be part of a wider develop-ment plan. For example, roads are needed for access to health centres. Schools and media outlets are needed to create awareness among the people. In spite of all claims to give utmost importance to public health, health expenditure in the country has always been low. At present, India spends only 1.04 per cent of its GDP on public health, but China spends 3 per cent and the US over 8 per cent. Even the projected expenditure for 2020 is only 2.5 per cent. There is definitely a case for better allocation and utilisation of resources.