Maternal and infant health: long way to go

Baby feet in mother hands

The years come and go, but our state of health remains a concern. As a young medical student in 1980s, I remember the WHO slogan “Health for all by 2000”. I was probably naïve at the stage, looking ahead for 2000 with so much hope and aspiration only to realise that the year was all about millennium bungles with our computers rather than health.

Then came WHO’s new slogan Millennium Developmental Goals (MDG), especially MDG4 which excited me more. But yet again, nothing much came out of it, not until 2017-2018, when things started turning the corner.

The central government introduced several health schemes, rotavirus vaccine, pneumococcal conjugate vaccines (PCV) in four states on a pilot project with GAVI, while the Indian Academy of Paediatrics (IAP) and National Neonatology Forum (NNF) together pushed for Neonatal Resuscitation Programme (NRP).

This was a truly multi-pronged approach which led to a steady decrease in our long-stubborn Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR), rekindling the hope of single-digit MMR and IMR soon becoming a reality from mere slogans.

In population and standard of healthcare, India is like Africa and America combined — the healthcare is as good as any developed country in some private sectors while in some public sectors it is as good as remote Africa. Therefore, there needs to be a serious commitment from both the state and central governments along with public support.

Recently, on November 26, Union Health Secretary Preeti Sudan did a soft-launch of the Integrated Disease Surveillance Programme (IDSP) segment of Integrated Health Information Platform (IHIP) in seven states. The path-breaking initiative will provide near-real-time data to policymakers to detect outbreaks, reduce the morbidity and mortality and lessen disease burden in populations and offer better health systems. This initiative is truly commendable, as without accurate data, there is very little we can do.

The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), launched in 2016 for providing free and comprehensive antenatal care services on the ninth day of every month to women in their second and third trimesters of pregnancy at designated government centres, has had a huge impact. Similarly, the Pradhan Mantri Matru Vandana Yojana (PMMVY) provides a cash incentive of Rs 5,000 to encourage antenatal check-ups, institutional delivery and postnatal care among the marginalised pregnant women and lactating mothers.

This has significantly contributed to reining in maternal and neonatal mortality. Intensified Mission Indradhanush (IMI), a campaign mode vaccination programme launched by Prime Minister Narendra Modi in 2017, is one of the 12 best practices from around the world featured in a special issue of the British Medical Journal (BMJ).

Caring for new mothers

Rajasthan has a dismal record when it comes to caring for new mothers as more than 25% of them in Jaipur did not receive postnatal care either from a doctor, nurse, Lady Health Visitor (LHV), Auxiliary Nurse Midwife (ANM), midwife or any other health care personnel within 2 days of delivery, reveals the National Family Health Survey-2015-16 (NFHS-4).

Poor access to postnatal care is one of the leading causes of maternal mortality and infant mortality rates. Meanwhile, in the state, only 63.7% mothers received such postnatal care during the same time period. Reports have highlighted that a third of the world’s stunted children under five — an estimated 46.6 million who have a low height for their age — live in India.

While there is a lot to cheer about, there is also a lot to achieve. Multiple policy decisions in maternal health and nutrition with a focussed approach have got us close to achieving the national target of reducing the maternal mortality ratio to less than 100 by 2020. But there’s a long way to go. Though there is a lot of positive news, decades of neglected healthcare systems in India and their dark shadows cannot be eliminated with just a few years of hard work.

All such things can only be handled and improved with a multi-pronged approach which we have initiated. Public-Private Partnership (PPP) can go a long way to address many of these issues especially when our private health sector accounts for more than 70% healthcare needs of our country. In this respect, Ayushman Bharat is definitely shining a light in the dark tunnel, and one hopes the light still burns bright at the end of the tunnel.

(The writer is Chairman and Neonatologist, Cloudnine Group of Hospitals)

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