Health Mission’s giant task
by
AJ Philip |
Hard-working ANM shows the way
Among this year’s national award winners, announced on the occasion of the Republic Day, populated as usual by film stars, political leaders and industrialists was a little known lady from the Andaman Islands in the Bay of Bengal. For those who care to read such news-items, Shanti Teresa Lakra had won the National Florence Nightingale Award for nursing last year.
One of them was former diplomat and Vice-President Mohammad Hamid Ansari, who knew about the yeoman service the Auxiliary Nurse Midwife (ANM) — one of the lowest posts in government health service – has been rendering in a virtually inaccessible area in the Andaman Islands and recommended her case to the government for a Padma Shri.
A few days from now, Shanti will receive the prestigious award from the president at a glittering function in the Rashtrapati Bhavan. Nobody will ever grudge her the award, which she richly deserves. Her story began when she was posted at Dugong Creek, an island in Little Andaman. The island is home to Ongees, one of four Stone Age Negrito tribes, with such distinguishing features as “red eyes, dark skin and curly black hair”, who are believed to have migrated thousands of years ago from Africa.
Shanti had to walk through dense forests and cross two rivers to reach her place of posting. When she reached there, the Ongees were on the verge of extinction with their total population dwindling to a two-digit figure. The high infant mortality rate among them was mainly because of the lack of antenatal and neonatal care. Initially, Shanti faced a huge problem, for a pregnant woman would not even allow her to touch her belly for fear that it would harm the baby inside.
Gradually, she won the confidence of the women, who began to follow her advices. Soon, there was a dramatic turnaround in their situation, with a drastic drop in the infant mortality rate. At one time the population of the Ongees went up from 78 to 100, though it subsequently fell to 72, when some of them died because of drinking poisoned water.
Shanti did not leave the Ongees or her work even when Tsunami struck Andaman and Nicobar Islands and devastated the area. Though none of the Ongees died in the natural disaster, it affected their livelihood, dependent as they are on hunting of wild boars and ocean turtles with crude spears. What Shanti’s achievement underlines is that with sincerity of purpose and dedication, health professionals can transform the healthcare system in the country.
Unfortunately, health is a neglected sector in India. Not even one per cent of the Gross Domestic Product (GNP) is spent on health. It was to address this problem that the National Rural Health Mission (NRHM) was initiated in 2005, with clear targets to achieve by the year 2012. The mission was particularly targeted at 18 states, which had a comparatively poor record in health services.
Has the mission achieved anything substantial? Let’s go by some figures released last week by the Registrar General of India for the year 2009. The Infant Mortality Rate (IMR) is now down to 50 per 1000 live births. Even the least developed states like Bihar, Orissa, Rajasthan and Uttar Pradesh, collectively called “Bimaru (chronically sick) states” have achieved considerable progress in bringing down the mortality rate.
It is true that India does not have a dependable system of registering all births and deaths. Infant deaths are seldom reported which raises questions about the correctness of the IMR figures. A better idea of the progress will be available when the annual health survey organised by the Census of India’s office, which is now under way in 284 districts, including all the districts in nine states like Bihar, Uttar Pradesh and Madhya Pradesh is completed and the results are available by April-May this year.
The Health Mission seeks to bring down the Infant Mortality Rate to 30 and the total fertility rate to 2.1, which is the replacement level, by 2012. For starters, that is the level at which population growth will stabilise, a point in development a state like Kerala has nearly reached.
With less than two years to go, there is scepticism that the health mission has bitten off more than it can chew. Amarjeet Sinha, who heads the mission and who started his civil service career with a posting at Chaibasa in one of the most backward regions in the country, is honest enough to admit the impossibility of the task. Give him two more years and, he says, the mission would be able to achieve all the targets.
Of course, there are experts who do not give much credit to the mission on the ground that out of 25,000 medical graduates who enter the field of healthcare every year, only a small percentage joins the government sector. Private healthcare professionals can, therefore, claim as much credit for the drop in the infant mortality rate as the health mission authorities.
Such hair-splitting will serve little purpose when the stark fact is that the commitment of the government to increase the spending on healthcare from 0.9 per cent to 2-3 per cent of the GDP remains only on paper. Consequently, there has not been much change in the situation in which over 40 per cent of hospitalised Indians borrow heavily or sell assets to cover expenses.
Similarly, over 25 per cent of hospitalised Indians fall below poverty line because of hospital expenses. A few years ago, Pratichi (India) Trust, set up by Nobel-laureate Amartya Sen, did a study in Jharkhand and found that in the villages surveyed, the people did not have access to a dependable, cheap healthcare system forcing many of them to turn to quacks.
A little survey this writer made three years ago in a few villages in Punjab, one of the most developed states, and close to Chandigarh, which has one of the best healthcare system in the country, revealed the pathetic condition of the public healthcare system. The National Rural Health Mission also has the target of having a qualified health worker in every village in the country.
Shanti Teresa Lakra has shown what one person can do if she is passionate about her work to the point that she can even leave her own son to the care of her relatives so that she can concentrate on her work. We need more such ANMs than another recipient of the same Padma Shri this year who left government service to set up a private hospital with five-star facilities.
(The writer is a New Delhi-based senior journalist)
Oman Tribune |
Other comment for AJ Philip
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| NEWS UPDATES |
|
|
|
|
|
|
