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No shot in the arm

Half of India's health problems will be solved if preventive care is made a priority. One way of doing this is to give more weightage to vaccines, writes Lalita Panicker.

india Updated: Sep 10, 2011 19:36 IST
Lalita Panicker

One of the enduring mysteries of the UPA 2 government is what the health minister has been doing all this time in a country which has the highest disease burden in the world. In the case of the last minister, the irrepressible Anbumani Ramadoss, we knew all about the Don Quixotic battles he fought at the cost of real health issues. But the amiable Ghulam Nabi Azad, we are sure, will let us know one of these days what his blueprint for health in the country is.

There are certain immutable facts about the health sector. One is that spending on it is not likely to go much beyond the less than 2% of the GDP that it is at present. It is also fairly certain that the issue of health is not going to set campaign trails on fire as we go into assembly elections in five states. In fact, it has never been an issue in any election, even in states which suffer the most from crippling diseases and have high maternal and child mortality.

But instead of kvetching and grumbling about things we can’t change, it might be worthwhile to rearrange the priorities on the health wish list. It is now quite clear that the curative approach is not going to work. By the time we get our public health system up and running, it will be too late for far too many people, the bulk of them children who are most vulnerable to killer diseases. If the government would make preventive health care its top priority, more than half our health problems would be solved.

Let’s look at our universal immunisation figures. That only 58.5% children are fully immunised by the age of one year shows that our health system has not taken this issue seriously enough. In fact, the opposite seems to be happening. The budget for routine immunisation came down from Rs 618 crore to R511 crore from the last to this budget. There are simple and cost-effective solutions for many childhood diseases that can ensure that children don’t die before they are five. Promoting oral rehydration therapy that is nothing more than administering a sugar and salt solution could prevent so many children from dying of diarrhoea.

Pneumonia is another killer in children which can easily be prevented with vaccines. It is passing strange that with 20% of all child deaths taking place due to pneumonia and diarrhoea, the vaccines to prevent the most common causes of these diseases have not been included in the national immunisation programme. It is a very small investment to ensure that we realise our demographic dividend some years down the line.

Most mothers, even among the educated, do not know the value of proper sanitation when it comes to their children. It is quite a common sight in cities to see mothers begging at street corners, cradling infants and holding filthy feeding bottles filled with what looks like milk. Breastfeeding has enormous potential to save the lives of babies, but there are few effective interventions through the many child programmes that the government has set up to disseminate this message.

Instead of trying to improve the health system at all levels, and god knows it needs that and much more, if the government were to give more weightage to vaccines, most of which are available in our thriving private sector, we could be off to a good start in combating other problems like rampant, drug resistant tuberculosis, cardiovascular diseases and a host of communicable diseases that invariably come during the monsoon months.

It is no one’s contention that Azad takes to the field himself and try to inculcate awareness of children’s health in their parents or medical helpers. But, sadly in India, little gets done unless there is a political push. And when politicians put their minds to an issue, it gets done with spectacular success like the polio immunisation drive. Cricketers to filmstars, all lent their voices to the campaign and it worked. We can’t quite see the same level of enthusiasm for illnesses like diarrhoea and pneumonia which do not have physical manifestations like polio. The child gets these diseases, wastes away and dies.

All political parties have a huge asset which they do not make enough use of for the greater national good and for the more venal reason of getting votes. They have gigantic youth wings: the Akhil Bharatiya Vidyarthi Parishad of the BJP, for example, expends its energies beating up sundry lecturers, the Shiv Sena’s youth wing patrols the streets for any sign of behaviour not in conformity with Indian culture and we don’t know much about what the other youth wings do.

These young, energetic souls could be drafted into promoting awareness of child and maternal health. After all, even from a purely selfish point of view, a family which benefits from such interventions is likely to vote for the party which helped it. We have seen that grand central schemes do not always work. But at the block level and zilla level, these youth wings could start an aggressive immunisation drive for easily preventable diseases like pneumonia and diarrhoea.

In all nations on the rise, healthcare gets progressively better as GDP grows. It would seem that India is bucking the trend. At the risk of sounding like Medha Patkar or Arundhati Roy, it is difficult to stomach the fact that children must die for want of interventions that cost a laughable amount when we can accept that people consider it a mere bagatelle to splash out R250 crore on a wedding.

If the government finds it hard to raise the money to incorporate these vital vaccines into the national immunisation programme, nothing stops it from exploring a productive private-public partnership on this issue. We have the technology, we have the vaccines and we have a burning desire to cash in on the demographic dividend. So what are we waiting for?

The young Congress general secretary has been trying to galvanise the grassroots of the party, and more power to his elbow. He might also think about lending his considerable weight to ensuring that conditions obtain which will allow our children to survive, allowing them to enjoy an India which they can, if they have the health and skills, catapult into the first world. If the party of governance shows the way, surely others will follow.