Reinventing child healthcare in India

The recent move by the State Institute of Health and Family Welfare, Karnataka, to collaborate with the Singapore International Foundation and Singapore Health Services for the project, ‘Enhancing Maternal and Child Health Programme,’ by providing training to the health workforce from the state will go a long way in reducing its maternal and infant mortality rate.

The move assumes special significance due to the fact that Singapore has a maternal mortality rate (MMR) of five per one lakh and infant mortality rate (IMR) of 1.7 per 1,000, while it’s 128 and 31, respectively, in Karnataka.

The provision of child healthcare in India is beset with numerous challenges. About 30 babies are born every minute. India and China account for nearly a third of the world’s child deaths and a vast majority of them are in India.

India witnessed 2.1 million child deaths in 2013, more than in any other country in the world. Despite a modest economic growth, India has failed to provide basic healthcare to its poorest children. The inadequate number of government hospitals and the limited coverage of health insurance (only 1% of the population) force people to incur heavy out-of-pocket expenses for availing the services of private healthcare providers. The cost of treatment is often the determining factor in choosing a provider and service.

The rich-poor divide is rising at a troubling rate in India, leaving a vast number of mothers and children at the risk of increasing poverty. Avoidable diseases like pneumonia and diarrhoea and a high rate of malnutrition are the major causes of child deaths in India.

One out of every three women is underweight which puts them at the risk of having low birth weight babies. These babies are 20 times more likely to die in infancy than healthy babies. Pregnancy and child birth related complications contribute to suffering and mortality. Experts say that poverty, ignorance and poor feeding practices often result in high rates of malnourished children.

The prevalent gender discrimination ensures that life expectancy of girls is lower than that of boys. Boys are more likely to be immunised than girls and have better access to healthcare. Female children have to struggle hard to survive.

In rural India, the socio economic prosperity and level of education is low. Villages lack even primary healthcare facilities. Child specialists are few. Though child mortality is as low as 10 per 1,000 in cities, it is more than 150 in villages.

The high IMR signals the risks from infectious, parasitic, communicable and other disea-ses associated with poor sanitary conditions and malnourishment. The type of care received at child birth is often critical for the health and survival of both the infant and the mother. While India has failed to make significant progress in arresting child mortality rate and malnutrition in children, Bangladesh and Nepal have outperformed it.

Much of the problems stem from the fact that the concept of public health is often misunderstood and misrepresented by the government and the NGOs.They continue to emphasise curative or medical service as a major part of public health.

What we really need are health promotion and disease prevention activities through an integrated approach. Public health should stress to prevent, control and eliminate commonly occurring communicable and non-communicable diseases.

Even though appropriate vaccination programme is in place, the children are adversely affected by the lack of proper health services like good sanitation, quality drinking water; drainage system etc. Revival of preventive medicine is the need of the hour.

With the advent of neo-liberalism, the new hospital industry is trying hard to exclude the government from the field of healthcare. The present health conditions of the country are below that of the developed countries of 1940s.

India should increase spending on public health by at least 2% and involve communities in order to strengthen the system. Efforts are needed on a war-footing to make a difference to the health of those millions of children being born and growing up in India.

The contribution of the private sector in providing primary, secondary, and tertiary services should be enhanced through various measures including partnership with the government. New born and child health services have to be implemented in the country with the aim of reducing neonatal, infant, and child mortality.

It is gratifying to understand that steps are being taken through home-based newborn care, integrated management of neonatal and childhood illness, skilled are at birth, breastfeeding practices, school health programmes, etc, to revolutionise child healthcare in India.

(The writer is a Bengaluru-based professor of health economics)