There is a bounce, an energy and even a jauntiness these days in urban India. An economy in rebound, new political scenarios and global plaudits — spring, it seems, is in the air. Sadly for millions of India’s poorest mothers and children, seasons barely change. Between conception and till five years after delivery, anaemia prevails in over 50% of mothers. About 1.3 million children die before they are five years, more than half of them in their first 30 days. Of the children who survive, over 40% are malnourished.
The basic solutions to most maternal and child health (MCH) problems are known. There is a structure for public health delivery down to the villages, and well-conceived programmes exist. The problems many states face is not of funding, but how to spend the allotted money. Scaling up is the biggest challenge in India’s public health delivery.
Recently I met Chanda, 23. Gokul, her fourth child, had just died. He weighed less than two kilogrammes at birth, and died within two weeks due to diarrhoea. Scaling up MCH delivery requires effective supply, vibrant demand and an enabling environment. The supply side did not serve Chanda. The nurse-midwife had no data on Chanda. The baby was born at home and could not be treated since there was no medical practitioner nearby. Vibrant demand implies an aware and empowered consumer. No one told Chanda about the importance of ante-natal check-ups, post-natal hygiene, or exclusive breastfeeding. She began breast-feeding two days after Gokul was born, as her father-in-law was away and his blessing was required. Chanda was neither aware nor empowered.
An enabling environment reinforces supply and demand. Social and cultural norms are crucial. Village structures, such as panchayats and women’s groups, must be supportive. There must be media interest and policy cover. None of these applied for Chanda. There are programmes across India that resolve these issues innovatively for particular segments of the maternal and child health spectrum. There are some that integrate across segments. The scaling up of these programmes to a state level does not happen automatically. It requires partnership between a visionary state government, a capable implementer and a rare type of donor. There is an urgent need for implementing agencies that bring knowhow of delivery at scale from experience and inquiry.
Many donors do not consider scale or sustainability. Health delivery deploys many business methods. This suggests a natural appeal for CSR funding and philanthropy. Donors willing to risk the uncertainties of health delivery at scale and the embracing of possibly thorny government partnership are needed.
We see a visionary government and new-game donors emerging. Perhaps spring is in the air after all.
Ashok Alexander is the head of Antara, an NGO. The views expressed by the author are personal