From cradle to grave
The recent crib deaths in Bengal prove once again that the funds meant for the National Rural Health Mission are being grossly misused, writes Sumit Mitra.india Updated: Nov 07, 2011 23:16 IST
Recently, when the bullyragging anchor of a news channel was pushing around a somewhat sheepish medical bureaucrat from West Bengal, for nothing short of a confession of guilt regarding the 17 infant deaths between October 25 and 28 at Dr BC Roy Post Graduate Institute of Paediatric Science in Kolkata, it made viewers think that the babu deserved it. However, if the anchor was less angry, and more questioning, he could have asked: "How many of the dead babies were less than four weeks old?" The reply would have been, "all of them." And that holds the key to the uproar over crib deaths in West Bengal.
After being sandbagged by the media, the poor excuses offered by satraps of the Trinamool Congress, the ruler of the state, were clumsy and callous. Sudip Bandyopadhyay, who had egg on his face by being the Union minister of state for health, said that "such child deaths in large numbers are quite normal. I don't know why so much of uproar is created on child deaths in the state."
Besides betraying utter naiveté in responding to a public tragedy, he was too clever by half in trying to cover up the deaths of the most vulnerable members of the human race, babies who are less than 28 days old. Mahatma Gandhi asked his disciples to recall, before committing an act, "the face of the... most helpless man" and see if it's going to be "of any use to him". And who could be more helpless than the little baby, especially if it is born with a medical handicap?
In fact, the Bengal baby deaths raise serious questions about the fate of the $14.3-billion National Rural Health Mission (NRHM). It was launched in 2005 with fanfare and was aimed at reducing maternal and infant mortality rates. Now the mission appears to be fraying at the edges. There have been some gains, though, in health parameters with relatively easy hurdles to cross, such as the maternal mortality rate and the infant mortality rate. But the slopes on even these curves are irritatingly gentle, and they are still one or two decades away from the Millennium Development Goal (MDG) laid down by the United Nations for 2015.
But babies who are not even a month old present an altogether different problem. They need special care. And they put the government's commitment to real test. In Bengal, the sickly among these babies were sent by droves to the top paediatric hospital in Kolkata after hospitals in the districts had refused them. Sick newborns require a separate sterilised room, as they have poor immunity and may catch infections if kept with older babies. This is the reason why doctors even in district hospitals, where this facility is limited, refuse to admit sick babies. On days when too many babies fall sick, the resources at the tertiary referral hospital in Kolkata come apart under pressure. It happened last month. It happened in June, a month after Mamata Banerjee had assumed office as the state's chief minister. It also happened in 2002, when Suryakant Mishra, the then health minister, said the same lines, "there is nothing unusual in the deaths," that Bandyopadhyay is echoing, and Banerjee promptly took to the streets.
What politicians are ignoring is the soft underbelly of the NRHM, its incapacity to protect the most vulnerable human beings. About 900,000 of them are dying every year, the neonates mortality rate being, at 34 per 1,000 live births, miserable; it was 44 a decade earlier. There are three neonates among every four babies dying before their first birthday. As far back as 1990, when 4.6 million neonates died every year worldwide, India accounted for 29.5% of those unfortunates. In 2009, the total number of neonate deaths had come down to 1.7 million, but India still had a 27% share.
Neonates with infections or breathing problems, or born prematurely within 28 weeks of pregnancy, need to be put in a Sick Newborn Care Unit (SNCU) equipped with individual warming and monitoring devices, infusion pumps, portable X-Ray and in-house lab, etc. The irony is, Dr BC Roy Hospital had its first set of SNCUs two days after the procession of baby deaths. And Ghulam Nabi Azad, the Union minister for health and family welfare, who recently advised Indians to have "at least two children" and not one, like the Chinese, is now promising an SNCU in every district hospital.
The wise minister could check instead if the NRHM funds are being properly utilised. So rampant is corruption in its working that three senior medical officers of Uttar Prad-esh have been murdered, including one in jail custody; he was allegedly the kingpin of the racket. Besides, some of the mission's prize components seem hopelessly ineffectual. Janani Suraksha Yojana, for example, offers cash benefits to poor women for institutional delivery. Why then is the country's figure for hospital delivery still languishing at 41%? Rather than advising couples to keep on producing children, why hasn't Azad seen the connection between the security of institutional delivery and the consequent better chances of the baby's survival?
Government health facilities in India are a joke. In West Bengal, where the tragedy has caught the nation's attention, 349 paediatricians are required at the community health centres (CHC) but only 25 are in position. The CHCs need 1,396 specialists but only 186 are in position. It's the same story across north India. There is a crippling shortage of trained health workers. Indiscipline is everywhere. Dogs lie in patient beds. Employees sit in cots meant for babies. Doctors slink away from hospitals to practise in private nursing homes down the lane. It just needs another Comptroller and Auditor General prodding to discover how creative the NRHM's accounts may have been.
Sumit Mitra is a Kolkata-based writer. The views expressed by the author are personal.