This week, the injectable Hepatitis B vaccines were mistakenly given orally to young children instead of polio drops in West Bengal. It did not cause physical harm, but did immense damage by reinforcing existing suspicion of vaccines and mistrust of government healthcare delivery.
Why does India do such a bad job of looking after its newborns? It’s certainly not short of funds. The UPA’s flagship National Rural Health Mission has an enviable budget of Rs. 21,229 crore. It’s also not just the sheer numbers — 26 million babies, the most in the world, are born in India each year — overburdening public health infrastructure. This would be a problem where public health delivery exists, but most parts of India remain underserved, forcing people to turn to private practitioners and quacks.
Five major low-performing states — Uttar Pradesh, Bihar, Rajasthan, Andhra Pradesh and Madhya Pradesh — together account for one in four births in India. Except for Andhra, which is marginally better, healthcare delivery in these states varies widely among districts.
On paper, the district hospitals, primary health centres and sub-centres are overstaffed, but on the ground, at times even the roof and walls are missing. There is electricity, but supply is undependable at best. There is piped water, but taps run dry. I’ve been to a health centre in the Morena district of Madhya Pradesh with no running water and a hand pump funded by a government scheme that had not been bored in. The families of patients got water in buckets from a kilometre away, spilling half to reach in time to catch the doctor who was there for just two hours a day, if at all. I’m sure there are photographs of the hand pump in a government file, just as there is an attendance register that shows the doctor was there.
Improvements in child survival can be dramatic if governments put their minds to it. In Brazil, the under-5 death rate decreased by 77% from 1990 to 2012 because of improved sanitation, educating mothers, promoting breast-feeding and expanding immunisation. Ethiopia recorded 67% reduction in the same period by using health-extension workers to immunise and treat severe malnutrition, diarrhoea, malaria and pneumonia in areas where health infrastructure is missing.
Closer home, Bangladesh has lowered deaths of children under five years by 72% by immunising children against killer infections such as pneumonia, tuberculosis and malaria, among others; teaching mothers to use oral rehydration therapy to treat diarrhoea, and giving children Vitamin A supplementation.
In comparison, child mortality rate in India has dropped by 45%, but it still counts for more than one in five under-5 deaths, said a UN report released last weekend.
In 2012, roughly 6.6 million children under-5 years died worldwide. About half of under-five deaths occur in five countries — China, India, Democratic Republic of the Congo, Nigeria, and Pakistan. India (22%) and Nigeria (13%) together account for more than one-third of all deaths, said the UN’s 2013 Progress Report on Committing to Child Survival.
Globally, about 45% of under-5 deaths are linked to undernutrition, with pneumonia, prematurity, birth asphyxia, diarrhoea and malaria being the leading causes of death. Up to half of all newborn deaths occur within the first day, which would not happen if their parents had access to basic health-care services such as skilled care during and after childbirth; inexpensive medicines such as antiseptics and antibiotics; kangaroo-care information, and exclusive breast-feeding for the first six months of life.
With a net addition of 17 million to its population — the Netherlands has 16.2 million people — each year, India has work cut out ahead. Establishing brick-and-morter infrastructure and training doctors will take years to meet demand. An effective stop-gap would be to empower community workers to treat basic infections and work with the community to proactively seek and demand quality health services.