“We do not inherit the world from our ancestors. We borrow it from our children”.
~ A Native American Proverb
Each and every citizen of this country dreams about India becoming one of world’s super-powers and economic hubs. Are these just dreams or tall claims? Does India have the potential and prospects of becoming the centre of global power? The dreams could perhaps become true provided the status of our children improves. However, as of now the state of the nation when compared to the status of our children shows appalling figures. They are disturbing and pathetic. In 2009, the number of reported cases of polio in India stood at 741 children, more than any other country of the world. On January 13, 2012, India had successfully recorded one year without a single reported case of polio. We could proudly say that World Health Organization (WHO) appreciated India for having accomplished this herculean task. The pride and the laud get dissipated within a fraction of a second as we look into the big picture. Every year, India loses more than 14 lakh children under the age of five to diseases that are fully preventable through immunization. The cruelest fate for parents is to outlive their own children. Quite often this fate is reserved for the poorest segments of our society. Parents who could afford premium vaccines do not depend on government sponsored immunization program.
Poverty and hunger contribute because those who are afflicted by these diseases have no means to treat or prevent them. Children who are afflicted with diseases such as diarrhea and pneumonia need expensive ongoing treatments in order to save their lives. So the burden of childhood diseases on the poor only serves to worsen their conditions, driving them into intense poverty and debt. By and large parents with their limited resources try their level best to save the lives of their children, but invariably pushed to more debts and the treatment fails and eventually majority of the children die. Among those who live in the slum and in rural areas especially the Dalits and the Tribal witness the death of children under the age of five. This has become all too common. Precisely due to these reasons many name their children who have completed five years. India has become the site of nameless children. These are preventable diseases, and what is needed simple act of immunization that can save hundreds of children.
Healthcare in India is nothing but a long litany of insufficient resources and poor outcomes. GDP and other focused investments on health are way down as compared to other areas. So India falls way down the guidelines of WHO both in quantitative and qualitative terms. For example, bed density is low (less than 1.5 beds per 100 persons as compared to WHO guideline of 3.5), doctors few (less than 1.8 per 1000 as compared to WHO guideline of 2.5), and out of pocket spend high spend high (86% as compared to an average of around 40% for low income countries). Rural India lags even further behind, with around 30% of the rural population having to travel over 30 km for treatment.
Furthermore infectious and chronic diseases continue to prevail. Health indicators continue to lag; healthcare spending is growing lower than GDP growth. In tune to this, hospitals also have failed to translate better health care. More and more multi-specialty hospitals have and thus catering to the rich and the poor continue to depend on government hospitals. States with more doctors have done better in health indices than the states that have better infrastructure. Doctor to population ratio had a far higher impact on infant mortality rate (IMR) or maternal mortality rate (MMR) than better infrastructure. To cite a few examples Tamil Nadu has few primary health centers (PHCs), one per lakh of population, as compared to Chhattisgarh and Odisha that have two PHCs is better placed in health outcomes.
Tamil Nadu has one doctor for 789 patients and an infant mortality rate of 21 and maternal morality of 97. In sharp comparison, Chhattisgarh has one doctor for 6,221 patients and witnesses 47 infant deaths for every 1,000 live births and 269 maternal death per 1,00,000 live births. Odisha that has one doctor for 2,500 patients, too, suffers from high infant and moth deaths. It has IMR of 53 and MMR of 258, respectively. Interestingly, states like Andhra Pradesh, Goa, Karnataka, Kerala and Tamil Nadu alone account for 42% of all medical colleges in India, thereby producing most of India’s doctors. Not surprisingly, these states also have the best Doctor Population Ratio (DPR). These states show no shortfall of doctors at PHC level and have already met the Millennium Development Goals (MDG). At least three of the five – Kerala, Goa and Tamil Nadu – have IMR below 21. Incidentally, West Bengal has one of the highest per capita coverage of primary health centers – nine per lakh population. However, it has just one doctor for 1,508 patients and IMR of 32 while MMR is 145.
In comparison, North Indian states of Madhya Pradesh, Bihar, Uttar Pradesh, Odisha and Chhattisgarh have very few medical colleges, a fact which reflects in the DPR. By and large, most states with poor DPR also had a relatively high shortfall of doctors at the PHC level. For example a state like Bihar has one doctor for every 2,785 people. This translates to IMR of 43 and a MMR of 261. When these numbers are viewed against the Millennium Development Goals (MDG) target of 27 for Infant Mortality Rate in India by 2015, it becomes clear that these states need to act urgently to improve their performance in public health. All these parameters reflect clearly that the nation and the states should go beyond merely having doctors and invest in improving the quality of healthcare professionals in India. The Centre and the states should go further greater public investment in healthcare, and improve the quantity and quality of healthcare in India while reducing regional disparities. Along with these factors there should be efficient utilization of funds, good quality of human resources in health care and finally awareness among people.
Connected to ill-health is illiteracy and absence of quality education. With over 300 million students and 6.5 million teachers, India’s education system touches most families. Parents face a number of problems in organizing education for their children. Increasingly it causes great concern for families. Nationally, nearly half the students who enter class 1 are out of school by Class 10. This varies across states – 77% in Assam, nearly 70% in Jharkhand and Rajasthan to a more manageable 16% in Himachal or about 25% in TN and UP. Dalits suffer a dropout rate of 56% and Adivasis 71% amongst the most disadvantaged sections in India. In villages over 51% of the poorest is illiterate and only a minuscule 0.4% goes beyond higher secondary. In cities, 42% of the poorest remain illiterate, just 1.5% complete higher studies. Incidentally, more than three quarters of schools in the country do not have fully equipped science laboratories for students in class 11 and 12 from a survey that stretched out to 2.4 lakh secondary and senior secondary schools. In other category where an integrated science module is taught to students, over 58 per cent schools do not have the required laboratories. About 2.3 crore children in India, up to 6 years of age are suffering from malnourishment and are under weight. This staggering number amounts to over 28 per cent of the 8 crore children who attend anganwadis across. In Bihar, the proportion of under-weight children is nearly 50%, Andhra Pradesh (37%), Utter Pradesh (36%), Rajasthan and Chhattisgarh (both 32%) are some of the other large states with a high proportion of children being malnourished. Delhi reported that a shockingly high 35% of the nearly 7 lakh children who attend anganwadis were underweight. This shows that the extent of poverty and malnutrition amongst the urban poor is comparable to rural areas despite all the advantages the cities. In all the northeastern states except Assam, Tripura and Meghalaya, less than 10% of children were underweight children. Other large states with a comparatively low rate of malnutrition are Maharashtra (11%) and Tamil Nadu (18%).
The state of the nation is very much dependent on the status of the children. The state has failed translating health and education to the deprived and vulnerable communities. Majority of children in India have no access to quality education and health. In such an appalling scenario how could be talk and dream of India becoming one of world’s economic and military super power. Children are nations’ future and this segment is handicapped without quality education and health. A nation with poor health and literacy indices cannot dream and visualize a better future. The governments both at the Centre and the states should give more emphasis to these two sectors. Without these two the state of the nation could perhaps be termed as poor nation because society is obviously is sick.
These deprivations are reflected in multiple forms such as children working as domestic helpers, seen in two wheeler and four wheeler mechanic shops, dishwashers in hotels and tea stalls, helping the parents in the construction sites, rag pickers, maimed and turned into beggars, trafficked for a number of purposes. Children are precious and center of everything. Exploiting them for human greed and selfish aggrandizement reflects sick and pervert mind of the society. Any civilization or culture or ethos is primarily gauged by the status of children. As of now the state of the nation is in dire straits and so let us first talks about the status of children and then others will automatically follow suit.
DR. JOHN MOHAN RAZU
PROFESSOR OF SOCIAL ETHICS
CTC, MOKOKCHUNG
