Child health is basic to building the well-being and capabilities of the future of a growing nation. It is a great social responsibility in which the state has to play a critical role. It appears this primary responsibility is forgotten in the single-minded pursuit of economic growth. This article makes a comparison of six selected variables of child health status chosen from the 3rd and 4th National Family Health Survey (NFHS) for 14 major States.
The States reckoned here are Bihar, Gujarat, Himachal Pradesh, Haryana, Karnataka, Kerala, Maharashtra, Madhya Pradesh, Odisha, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and West Bengal. They account for 81 per cent of India’s total population. Andhra Pradesh is omitted for want of comparative data. A decade (2006-2016) is a reasonably good period to evaluate the progress made and gauge the trend. The comparative analysis tells a disquieting story.
From 1992, the Union Ministry of Health and Family Welfare has been publishing reports covering a wide range of health status data on children, women and adults. From this, the data I have chosen relate to children of age 12-23 months fully immunised (BCG, measles, and three doses each of polio and DPT); children of age 12-23 months who have received BCG; prevalence of diarrhoea in the last two weeks preceding the survey; children under 5 years who are stunted (height-for-age); children under 5 years who are wasted (weight-for-height) and children under 5 years who are severely wasted (weight-for-height).
The variables are pertinent to evaluate the health status of children below five years. The first three are indicators of preventive and protective child care. Normally, one would not expect a negative trend in any State on full immunisation of children between the age 12-23 months or at least with regard to BCG vaccination taken alone.
A comparison of NFHS data 2005-06 with 2015-16 shows that Himachal Pradesh, Haryana, Maharashtra and Tamil Nadu have registered a decline in the percentage coverage of BCG, measles and three doses each of polio and DPT. Besides that, the childhood illness of diarrhoea has increased by 2.22 per cent.
This portends an ominous trend which no democratic government can afford to ignore especially because the increase in diarrhoea is as high as 85.2 per cent in Uttar Pradesh and 48 per cent in Tamil Nadu. Maharashtra’s increase, although only by 4.94 per cent, offers no reason for comfort. The growing occurrence of diarrhoea is indicative of the endemic insanitary conditions and unsafe drinking water prevailing in the country even after 70 years of Independence.
The other parameters viz., children under 5 years who are stunted (height-for-age), children under 5 years who are wasted (weight-for-height) and children under 5 years who are severely wasted (weight-for-height) are anthropometric assessment of nutritional status of children below five years of age.Wasting woes
The intensity of stunting and wasting is measured as per WHO norms with reference to deviations from the mean, called in statistics as standard deviation. The index of stunting and wasting provides different information about body growth and composition, which is used to assess nutritional status. Children whose height-for-age is below minus two standard deviation from the median of the reference population are considered stunted (short for their age) and if below three standardisation (-3SD) severely stunted. Similarly, one can have wasted index for weight for height (-2SD) and severely wasted below three standard deviation (-3SD). To understand the severity of malnutrition, we have taken only severely wasted cases.
It is evident from the two survey data that all States have made progress with varying degrees of success with regard to stunting of children under five. For the country as a whole there is a decline in stunting at the rate of 2 per cent per annum during 2006-16. But the problem of wasting is pervasive and acute. Wasting is indicative of poor nutrition and may be the result of inadequate food intake. It is clear that nine out of the 14 States suffers from child wasting and that for the country as a whole it increased over 6 per cent during 2006-16.
The extent of wasting ranges from 4 per cent in Odisha to over 69.6 per cent in Punjab. Actually, the situation is alarming when we study the severely wasted cases which show an increase of 17.2 per cent at the country level and ranges from 17.65 per cent in UP to 167 per cent in Punjab and cover 10 out of the 14 States.
That Maharashtra reports 81 per cent, Haryana 80 per cent, Karnataka 78 per cent, Gujarat 64 per cent and so on, do not speak highly of the health care management and child well-being in these States. That even Kerala, known for its outstanding health attainments, has slipped down in regard to severely wasted children is something to be taken serious note of.Growth not enough
A closer analysis of the rate of achievements with reference to the six indicators of child health for the 14 States shows that States like Madhya Pradesh (with a per capita income of ₹63,323 in 2015-16) and Bihar (₹33,954, the lowest) have performed better than Maharashtra (₹1,52,853) or Punjab, or Tamil Nadu or Gujarat.
Maharashtra’s track record does not tell a story to write home about the quality of medicare delivery in the State. Indeed economic growth per se is not the necessary condition of human well-being, but deliberate policy choices and relevant social intermediation are equally significant.
It appears economic growth bypassed most of the poor children and their families isolated by social, cultural and geopolitical reasons in the absence of appropriate and adequate policy measures.
Evidently, the remarkable stepping up in the social sector expenditure during 2006-16 in Bihar and Madhya Pradesh compared to other States seems to have yielded returns. Economic growth is at best only a means to improve human lives and well-being and appropriate policy choices and actions are what matters.
The writer is Honorary Fellow, Centre for Development Studies, Thiruvananthapuram