Child health as a non-negotiable priority seems a far cry

While healthcare being a fundamental right is still a far cry, the Sustainable Development Goals (SDG) set by the United Nations to be achieved by 2030 has the health parameter clearly marked out among the 17 goals. This means, in the larger picture, healthcare is being looked upon as a non-negotiable part of everyone’s life, including children.

In a country where 39 per cent of the population constitutes of children, the best of the health practices start with bettering the health facilities accorded to them. Every child is also part of the larger populace who ought to have access to basic health facilities.

Stages of development

When it comes to a child’s health, measures have to be taken quite early; the most significant stages of development for the child fall between 0 to six years. Prenatal or ante-natal care for the mother plays a big part in the child’s well being. The Integrated Child Development Services Scheme (ICDS) in convergence with Primary Health Centres (PHC) has been taking care of this pre-requisite through Anganwadi Centres, ASHA (Accredited Social Health Activist) workers and Auxiliary Nurse Midwife (ANM) extending care and support to new mothers.

There are four rounds of check-ups included in the ante-natal care prescribed by the government, where the mothers are supplied with supplementary nutrition, medicines, iron and folic acid supplements, too. Frequent health check-ups are called for after the baby’s birth as well. While it is a commendable system from the vantage point of the uninitiated, the on-ground realities are indeed far from ideal.

Challenges

The southern states of Kerala and Tamil Nadu race ahead in health indices; 65 per cent women receive full antenatal care in Kerala (NFHS-4, 2015-16), whereas in Madhya Pradesh only 11.4 per cent women attained full ante-natal benefits. In Uttar Pradesh, it’s an even dismal six per cent. The challenges are many—from not being aware of the scheme and its importance, revised eligibility norms and poor provisioning, to name a few. To add to these, it has also been observed that in many places, health centres are not fully functional, equipment are unavailable, medicines aren’t restocked and health workers do not make regular visits.

Of the 9192 functioning health sub-centres in Madhya Pradesh, 5434 don’t have male health workers, and 1247 positions remain vacant for female health workers or ANM. Uttar Pradesh shows a similar trend with 4803 positions vacant for male health assistants and 2300 positions for doctors at primary health centres.

The absence of personnel and facilities can obstruct full and regular ante-natal care for the mother. This, in turn, can lead to the baby being born with a weak immune system and low birth weight. This is a misstep right at the start of the cycle of good health, for a baby that is born healthy is more likely to sustain the momentum and grow up hale and hearty.

Once the baby is about to be born, the next phase sets itself in motion. While institutional deliveries are recommended highly, there are still questions of access and quality that crop up in health facilities and women have to opt for home births. In Uttar Pradesh, institutional delivery shows an increase from 20.6 per cent (NFHS-3, 2005-06) to 67.8 per cent (urban and rural combined, NFHS-4); however, only 24.4 per cent children born at home receive a health check from a health personnel within two days of birth.

The dearth of personnel in the health facilities is among the main reasons for the baby to not receive the preliminary care she requires. Uttar Pradesh alone records a shortage of 658 gynecologists in the public health facilities, according to NFHS-4.

Immunisation of the child within the first year of her birth is crucial for her health. The major on-ground challenges here are busting the myth surrounding immunisation in certain communities and convincing the family of its importance and prioritising the child’s health.

Incomplete immunisation coupled with incorrect feeding practices in an unhygienic environment invariably leads to malnourishment, and makes the child susceptible to diseases. The infant mortality rates and under five mortality rates are also particularly high in Uttar Pradesh and Madhya Pradesh. While Uttar Pradesh registers 64 infant deaths and 75 in under-five mortality rate in the NFHS 4, Madhya Pradesh records 51 and 65 respectively.

While every stage of the child is important in her growth and development, the early years are crucial for her. Ensuring the health of every child is an investment that the nation makes for an improved demography. Retaining the care continuum for children between 0-6 years is essential for them to come out healthy, and the sooner the efforts are made to realize that, the better it is for our children.