Healthcare for children in India

Freedom from Hunger for Children under Six

Publisher: Save the Children, April 2009

Save the Children argues that the problem of malnutrition and infant and maternal mortality can be solved if it is addressed at the grassroots level in villages and districts with greater collaboration, consultation and joint action planning among; namely, the Ministries of Health and Ministry of Women and Child Development working together with the community.

This report attempts to capture the situation as it prevails on the ground today, especially with respect to child health and nutrition, maternal health and the existing interventions to address these.

It attempts to understand and appreciate the interconnectedness of maternal and child health and also the inter-linkages between health, nutrition, sanitation and livelihood security and explores alternative approaches and makes specific recommendations.

Of India's one billion plus population 158 million are between 0-6 years. Economic disparities between the rich and the poor have resulted to shocking hunger and malnutrition rates for large numbers of India's children.

The infant mortality rate in India is 57/ 1000 live births. The neonatal mortality rate is 39/ 1000 live births. Almost one in every three babies in the world who die before they are four weeks old is from India.

Public expenditure on health remains abysmally low in India and in some places financing for child nutrition have not been met. Programme for addressing the health needs of the children have failed invariably.

Save the Children latest report reinforces the urgency to tackle hunger and malnutrition on an emergency footing to meet the promises to the world and India's children.

It concurs that providing adequate nutrition to pregnant women and children under 2 years old is crucial. Many women here remain in ill health and are ill-fed; they are prone to giving birth to low-weight babies and tend to be unaware of how to breast feed their children.

Five inter-connected factors have been found to determine the nutritional status of children:

• Health and nutritional status of the mother during pregnancy
• Infant care and feeding
• Prevention of communicable diseases
• Timely and rational management of childhood illnesses
• Persistent poverty, seasonal food shortages and hunger and workload of the mother

The fundamental issue that emerges is that the programmes that were designed to address hunger, malnutrition, abject poverty and a host of other survival issues have not been able to deliver. While there is recognition of the need for a multi-pronged approach, departmental turfs have been impossible to overcome.

High levels of systemic inefficiency to deliver and monitor further compound this problem. Recurrent instances of large-scale corruption, lack of accountability of local level workers and leakages make the situation impossible.

Save the Children report highlights the need for India to engage with NGO partners to bring about sustained practice change on the ground – through intensive and targeted education and awareness, enabling people to become more vigilant about government programmes to improve the overall health and nutrition situation of children and enabling the most deprived to come forward with greater confidence and information.