Sunday, April 20, 2008

India failing to curb MMR and IMR

India is failing its women and children and is crawling towards the Millennium Development Goal (MDG), which targets to cut child death rates by two-thirds and maternal mortality by three-quarters between 1990-2015.

According to a report that tracks the progress made by 68 priority countries, which account for 97% of maternal and child deaths worldwide, only 16 (24%) were on track to meet the MDG compared to 7 of 60 (12%) in 2005. India, however, is not one of them.

In fact, India's progress towards MDG target in child mortality, in the report 'The Countdown to 2015: Maternal, Newborn and Child Survival' published in the medical journal 'Lancet', has been found to be "insufficient" and its level of maternal mortality has been termed "high".

While India's target under the MDG for mortality of children under age 5 is 38 per 1,000 live births, the number of children who die before their fifth birthday stands at 76 at present.

Infant mortality rate in India stands at 57 per 1,000 live births while neonatal mortality rate - deaths in the first month of life - stands at 43 per 1,000 live births.

Early initiation of breastfeeding benefits both mother and newborns. Yet, only 46% infants under six months are being exclusively breastfed. Also, only 41% births have been registered.

Speaking to TOI from Cape Town, Dr Francisco Songane, director of WHO's partnership for maternal, newborn and child health, said: "India, along with Bangladesh, Pakistan and Indonesia, contribute over 50% of all maternal and child deaths globally. What's worse, India is not making sufficient progress. India's population is massive and even if the ratio of maternal and child mortality may not be high, the numbers are staggering."

Dr Songane added: "India is among the 26 countries in the list of 68 where progress has been found to be insufficient. India has to scale up its interventions. Coverage rate will also have to be increased drastically as at present, pockets of population are not reached."

According to the report, brought out by the International Partnership for Maternal, Newborn and Child Health (MNCH), an umbrella organisation comprising about 240 members such as Unicef, WHO and Save the Children, India's average annual rate of reduction of child deaths between 1990-2006 has been just 2.6%.

If India wants to achieve the agreed targets by 2015, the required rate to reduce child and maternal mortality will have to be 7.6% from 2007-2015.

The report also identifies a series of missed opportunities. It says only one-third of women in the 68 priority countries are using a modern contraceptive method - a proven means of boosting maternal and infant survival.

Only 50% women and newborns benefit from a skilled birth attendant at the time of birth globally. Only about one-third of children with pneumonia, the biggest single killer of children, get treatment while under nutrition has been the underlying cause of 3.5 million child deaths annually, and as many as 20% of maternal deaths.

source - Times of India

Sunday, March 09, 2008

For better health, let's stick to the basics

The Economic Times, Gireesh Chandra Prasad, TNN

Given the state of affairs, the Economic Survey’s recommendations on healthcare might sound like truisms. But then, the truth does need to be oft-repeated. Not surprisingly, the Survey says that the central and state governments should make health insurance affordable to people and urgently improve the quality of basic services like drinking water and sanitation to address the poor health indicators of a nation of 112 crore.

Health insurance is critical in this scenario, given that it’s the poor service in state-run hospitals that forces people to seek expensive private treatment. It also is imperative that the delivery of public health services is improved. In fact, the Survey says a strategic focus on these areas should be the cornerstone of a successful policy framework for healthcare, given that state-funded healthcare for all still seems a distant dream.

India has one of the highest out-of-the-pocket household expenditures for healthcare. Then there’s the additional burden of user charges at state-run hospitals. Therefore, it is vital that innovative risk-pooling mechanisms are designed to improve access to healthcare, the Survey has said.

The data makes for depressing news. The latest figures on indicators like under-five mortality and maternal mortality rate shows that India fares worse than its more populous neighbour, China. Vector-borne diseases and epidemics are not under control.

In 2007, 940 deaths and about 10 lakh positive cases of malaria, filariasis, kala-azar, Japanese encephalitis, dengue and chikungunya were reported. Up to December 2007, 64 dengue deaths and over 5,000 positive cases have been reported while suspected chikungunya cases were more than half a lakh. Elimination of that old enemy, polio, is still not in sight with 471 reported cases last year.

Besides, there is a wide disparity among different states and urban and rural areas in access to healthcare. Life expectancy in Madhya Pradesh, Assam, Orissa, UP and Bihar, for instance, is noticeably lower than that in states like Kerala, Punjab, Maharashtra, Himachal Pradesh and Tamil Nadu.

This applies to infrastructure and medical staff too. Infant mortality rate is the highest in Madhya Pradesh while it is the lowest in Kerala. Most of the public health centres had operation theatres in Andhra Pradesh, Rajasthan and Maharashtra while the opposite was the case in UP, West Bengal and Chhattisgarh.

The Survey has recommended that there should be strategic focus on eliminating vector-borne and epidemic diseases, providing public health education, improving the urban and rural drainage system, providing clean drinking water and sanitation and a well organised garbage collection and disposal system. Mainstreaming traditional medicine would ease some burden on public health facilities.

Above all, good governance is very important in healthcare delivery. The 11th Five-year Plan envisages an investment of Rs 11.02 lakh crore at the central and state levels on social sectors. But greater allocation would not amount to much unless leakages in the system are plugged. Finance minister P Chidambaram had said on various occasions that outlay is not a constraint so long as it ensures outcomes. The government now needs to walk the talk.

Sick state of health in Madhya Pradesh!

View point Central Chronicle, Bhopal

Indore, Feb 16: Shivraj Singh government may receive laurels for his governance and pushing the state on the path of development, everything is not well as far as state of health in Madhya Pradesh is concerned. If one goes by the latest human development report of Madhya Pradesh, the state of health in Madhya Pradesh is far from satisfactory.

This is reflected from the latest estimate for longevity, measured as life expectancy at birth, which was 59 years for males and 58 years for females (corresponding to period 2002-06). As per the latest estimate on longevity as quoted in the Human Development Report 2007, the life expectancy for males and females in Madhya Pradesh was the lowest among all the major states in India and a good four to eight years lower than the national average.

States like Assam, Bihar, Gujarat, Haryana, Karnatakka and Kerala have better life expectancy at birth as compared to Madhya Pradesh. Even the state of Bihar which is counted among one of the most backward states in the country, life expectancy at birth for males and females (2001-06) stood at 65.66 years and 64.79 years respectively, much higher than that of Madhya Pradesh.

What has been found to be more surprising that while naturally female life expectancy should be more than male life expectancy, it is just the opposite in Madhya Pradesh, pointing towards discriminatory practices against both the girl child and women, leading to higher mortality rate.

Similarly, state's performance on the infant mortality rate (IMR) and the maternal mortality rate (MMR), is far below than the national average. IMR is related to combination of factors including poor nutrition for their mothers while pregnant, inadequate immunization of mothers from tetanus and lack of hemoglobin in their bodies, poor sanitary and health care conditions at birth, poor care during deliveries, etc.

The infant mortality in the state in 2004 was estimated at 79 (84 for rural areas and 56 for urban areas) as against national IMR of 58, the highest among all states in the country. Between 2000 and 2004, while the national IMR reduced from 68 to 58, the IMR of Madhya Pradesh dropped from 87 to just 79.

As far as maternal mortality rate is concerned, though the state had witnessed a significant reduction in MMR at 498/1000 (as per the National Family Health Survey - II) to 379/1000 as per the MMR data released in 2003, it was still far higher than the national MMR of 301/1000.

The public health infrastructure in the state is also far from satisfactory. As per the Human Development Report 2007, the state had a shortage of 26% in primary health centers, the very basis of primary health. The poor deliveries of primary health services in the state has primarily been attributed to doctors' unwillingness to serve in rural areas. Though the state has adopted an innovative approach of mobile health dispensaries through public private partnership and other health schemes, its impact on primary health is yet to be evaluated.

As per 2001 census, 22 per cent of the state population were directly at risk of water borne diseases as they did not have access to safe drinking water. As far as condition of sanitation is concerned, the state ranks far below than the national average. As per the survey carried out by the Ministry of Rural Development, Government of India, only 9.7% of rural households in Madhya Pradesh had a toilet in 2005, which is abysmally low even compared to the national average of 23.7%.

Krishna K Jha